Foreign and Commonwealth Office: Director for the Americas

Baroness Hooper: asked Her Majesty's Government:
	What plans they have to fill the vacant post of Director for the Americas in the Foreign and Commonwealth Office.

Lord Triesman: My Lords, Mr Steve Williams has been appointed Director for the Americas in the Foreign and Commonwealth Office.

Baroness Hooper: My Lords, that is very good news because, given the importance of Latin America to the world economy and our historic links with virtually every country in Latin America, distressing rumours were flying around that this post would remain vacant, or that the former incumbent would not be replaced. Will the Minister further reassure us by saying that both he and the DTI will in future attempt to co-ordinate their policies and use this useful geographical post to pursue them?

Lord Triesman: My Lords, I am always eager to co-ordinate with the DTI and just about anyone else. We will certainly do our very best to ensure that we have all of the impact that was successfully brought to the job by Robert Culshaw, who had a remarkable career. Perhaps I may, on everyone's behalf, wish him well in his new role as deputy director of the British Antarctic Survey. I should add, for clarification, that there has been some reorganisation across all such posts, which reflects our needs to achieve a more effective and efficient level of management.

Lord Wright of Richmond: My Lords, it is not perhaps for me to ask about the relative seniority of the replacement for Mr Robert Culshaw, who was a notably senior and experienced Diplomatic Service officer, but the change in arrangements for the Americas, following the Foreign and Commonwealth Secretary's Statement last December about the closure of posts, leads us to think that there may be inadequate resources from the Treasury for the Foreign and Commonwealth Office, in stark comparison with the resources made available to the Department for International Development. Can the Minister give us an assurance that the Foreign and Commonwealth Secretary will resist any further attempts by the Treasury to reduce the resources available to the Diplomatic Service?

Lord Triesman: My Lords, I also look at DfID and quickly remind myself that envy is a mortal sin. For our part, we will of course try to produce the most effective results with the resources that we have. I have no doubt that the FCO will be making the right arguments to try to ensure that we retain the resources we need. In respect of an important question asked by the noble Lord, in some areas we have seen some significant growth where the priorities of the United Kingdom demanded growth and the resources were moved to the right place. But, of course, everyone would always like more.

Lord Dykes: My Lords, at a time when many other EU countries are significantly increasing their diplomatic investment and infrastructure in Latin America, would it not have been very short-sighted if the Treasury had not eventually come up with the money? However, the Minister referred to reorganisation and perhaps reducing funding to some extent at the margin. Therefore, despite the new appointment, which is most welcome, the anxiety persists that the resources available will not be adequate when Brazil, Argentina, Chile and Venezuela, for example, are all becoming significant countries in that part of the world.

Lord Triesman: My Lords, I hope that the House will accept that my commitment to ensuring that we do a full and thorough job in Latin America, in a way that reflects the strategic importance of both the whole continent and particular countries in it, remains absolute. I think that most noble Lords will have seen that the Collinson Grant report on the Foreign Office suggested that some realistic delayering and efficiencies could be achieved. That means a bit of reorganisation, and it means moving on and responding in an organic way to the new demands. I hope that the House will see what I have said today in that context.

Lord Howe of Aberavon: My Lords, as ever, the noble Lord is showing his skill in putting his best face on a pretty dismal brief. Does he not acknowledge that it is very strange to compare the dire straits with which he is struggling with the fact that, since 1999, the total number of people employed by DfID has risen from 1,930 to 2,917—an increase of about 50 per cent? Over roughly the same period, the resources available to DfID have risen from £2.081 billion to £3.980 billion—an increase of almost double. Therefore, is it not very disturbing to find that a programme of closures, however much they may be presented as being for the sake of efficiency, is being proceeded with? For example, our post in Madagascar is being closed at a time when major British firms are undertaking fresh investments in that important country.

Lord Triesman: My Lords, I do not know whether it is putting a brave face on things but I do not think that we are in dire straits. The provision of services across the world is of a very high standard. We serve not only commercial interests but the interests of individual citizens who are travelling and so on. I think that most of us will view DfID's budget, which has, indeed, increased in the way that the noble and learned Lord described, alongside the transformation in the way in which we deal with aid and debt relief policies in trying to deal with AIDS and malaria and in trying to ensure that people whose lives are going backwards to extreme poverty, disease and a lack of education have that trajectory changed, and changed permanently. I hope that we will celebrate that.

Lord Lea of Crondall: My Lords, I very much echo what the Minister has just said about the importance of the growth in the resource given to DfID, and I am rather surprised at the note on that aspect struck by the noble and learned Lord, Lord Howe of Aberavon. Perhaps I may ask a question about transparency and the amount of information that will be given about the reorganisation. Some of us deal with officials in the Foreign Office from time to time. The noble Baroness, Lady Hooper, and I went to see Robert Culshaw before I led a delegation to Bolivia, and it was important that he was able to lend some weight as Director for the Americas in giving us an overview from Venezuela to Argentina and on the oil and gas situation. Now that the sectoral dimension is being brought forward, can the Minister put something on the website or place a note in the Library explaining how it will work?

Lord Triesman: My Lords, I am happy to ensure that everyone knows who is doing what so that they can get in touch with the appropriate people. I genuinely have confidence in the arrangements that we have made. We have appointed someone with considerable experience of both Latin America and the Caribbean Department. There will be a strong team of experts in London and, of course, in our posts in the area, many of which are headed at a very senior level. We would not have accepted—I certainly would not have done so—a set of arrangements in which we could not be confident. That would have been a foolish step on my part. I am confident in this arrangement, and I hope that that confidence at least conveys itself to the House.

Sports Stadia: Smoking Policy

Lord Hoyle: asked Her Majesty's Government:
	What steps they are taking to persuade the owners of sports stadia to make these non-smoking areas.

Lord Warner: My Lords, we have introduced the Health Bill, which provides powers to ban smoking in enclosed public places and workplaces and, potentially, in other places, such as sports stadia, as set out in the Explanatory Notes in paragraph 41. We are encouraging people to be aware of the health risks of second-hand smoke through our high-profile television campaigns aimed at protecting children and adults. Local tobacco alliances and primary care trusts have worked with local sports stadia to support their going smoke-free.

Lord Hoyle: My Lords, first, I must declare an interest as the chairman of Warrington Wolves Rugby League Club. Following an overwhelming demand from our spectators, we are implementing a ban on smoking in the new Halliwell Jones Stadium from season 2006. Despite what my noble friend says, there is an urgency about this. Will he try to persuade the Government to see whether, on health and safety grounds, other owners of sports stadia can do what Warrington is doing today and it is to be hoped the rest of the country will do tomorrow?

Lord Warner: My Lords, I am sure that we all recognise that Warrington is the epicentre of innovation and progress. I certainly congratulate my noble friend on the forward-looking policies adopted by Warrington Rugby League Club. I am not competent to comment on its performance on the field.
	There are many examples—I shall give a few from another sport—where stadia are taking forward similar policies. Examples are Derby County Football Club, Middlesbrough Football Club and the City of Manchester Stadium, where I believe that Manchester City play. They are all taking forward that policy and the local tobacco alliances and primary care trusts that I mentioned are working with sports stadia up and down the country to pursue the same policy as has been followed in Warrington.

Lord Addington: My Lords, will the Government confirm that there is a basic absurdity about having to watch any sport where athletes are running around through a fog of tobacco smoke? Will they further confirm that encouragement to ensure that that does not happen will be given so that the policy is introduced as soon as possible?

Lord Warner: My Lords, that is why we introduced a Bill with a provision in Clause 4 that enables regulations to be made to do the very things for which the noble Lord asks.

Baroness Howarth of Breckland: My Lords, if we have to look to Warrington to give leadership, can the Minister tell us when the Government will show some leadership to ensure that we do not have to worry about sports stadia or any other public place allowing secondary smoking?

Lord Warner: My Lords, the Government are delivering our election manifesto through the Bill, which will make enclosed workplaces covering 99 per cent of the workforce completely smoke-free. Currently, only 51 per cent of people report that their workplaces are completely smoke-free. I think that that is leadership in action.

Lord Winston: My Lords, does my noble friend have any scientific evidence that smoking in an open-air stadium is in the least bit harmful to health?

Lord Warner: My Lords, we know that smoking in the context for which the Bill will provide, where there are groups of people close together, may mean that some people are exposed to second-hand smoke. The evidence of the deleterious effect of second-hand smoke on health is very clear.

Lord Forsyth of Drumlean: My Lords, can the Minister explain to me why the same Government have concluded that one set of rules should apply to Northern Ireland and another to England?

Lord Warner: Devolution in action, my Lords.

Baroness Finlay of Llandaff: My Lords, as someone from a devolved Administration that wants to go much more smoke-free than does England under the Bill, we should congratulate the Government on the Tobacco Advertising Act, which is working well, but why on earth should 1 per cent of the workforce remain exposed to passive smoking if 99 per cent of the workforce will be protected? Are not the policies adopted by Warrington and the Millennium Stadium in Cardiff good examples and good ways to influence the population to allow that last 1 per cent of the population to be protected?

Lord Warner: My Lords, in launching this Bill we have already said that we will be consulting on how best to protect workers in the remaining 1 per cent of workplaces which are exempt from the proposals. We are clear about that, and will carry out that consultation.

Tonga: British High Commission Closure

Lord Beaumont of Whitley: asked Her Majesty's Government:
	What arrangements they are making for diplomatic representation at Nuku'alofa, Tonga, after 2006.

Lord Triesman: My Lords, the British High Commission in Nuku'alofa, Tonga, officially closes on 20 March 2006. The British High Commissioner at Suva, Fiji, will be accredited as non-resident High Commissioner to the Kingdom of Tonga. The High Commissioner is already accredited to several Pacific island states on a non-resident basis. The High Commissioner and his staff will make regular visits to Nuku'alofa to engage in a sustained way with the government of the Kingdom of Tonga.

Lord Beaumont of Whitley: My Lords, I thank the Minister for that moderately satisfactory answer. I chose Tonga out of several islands I might have chosen which are going to suffer this fate, because I was once a one-man delegation to Tonga, on the Government's behalf, for the Commonwealth Parliamentary Association. I hope that your Lordships are aware that it is the one country in the world where the upper House of Nobles has much more power than the lower House of Commons.
	Is there going to be any further closing down of representation to small countries which, on the whole, I would have thought deserve our representation just as much as the larger ones which cause considerably more trouble?

Lord Triesman: My Lords, I am grateful to the noble Lord, Lord Beaumont of Whitley, for his description of the superior House there. I am surprised they did not enlist his services to aid in their deliberations on a permanent basis.
	We have no plans for further restructuring. However, it would be foolish to imagine that other priorities might not arise at some future stage for any government, and that there might not be further rearrangements of our resources. In some parts of the world we are opening and expanding—for example, Baghdad, Basra, Kabul and Pyongyang. They are costly exercises, but they reflect real growth.

Lord Avebury: My Lords, notwithstanding what the noble Lord, Lord Beaumont of Whitley, has said about the position of the hereditary nobles in Tonga, is he aware that proposals have now been approved by the parliament, at the instigation of Prince Tu'ipelehake, one of the leading proponents of reform, to establish a constitutional reform committee among whose agenda items will be the replacement of the heredity peers by an elected element? Will the noble Lord therefore consider favourably any representations that may be received from Tonga, either directly or through the Commonwealth Secretariat, for constitutional advice or financial assistance in the process of the constitutional reform on which it is about to embark?

Lord Triesman: My Lords, I had not been aware of that proposed pattern of constitutional reform. I promise to study it with the greatest of care to see whether investment on our part is liable to produce a return that will satisfy this House.

Lord Wright of Richmond: My Lords, if I can impose on the patience of the House in asking a second question today, is it still Her Majesty's Government's policy to pursue a global foreign policy?

Lord Triesman: My Lords, yes.

Baroness Gardner of Parkes: My Lords, I have not been to Tonga, but I was a one-woman delegation to Fiji. Does the Minister recall that I asked a question about the closure of the various representations in Vanuatu and the other Pacific islands? The answer was that the same person, who clearly now is going to do the work for Tonga from Fiji, was doing it for those various other islands. People were very unhappy about those changes. Have they already been implemented and, if so, how are they working? Are people satisfied now?

Lord Triesman: My Lords, I believe—I shall check this—that they have been implemented. When we look at the level of representation that we have in those islands, it is against a background of there being, as far as I can detect, no requirements from anyone for any consular assistance in any circumstances in recent years. The workload is probably realistic across most of the tasks that we would expect consuls, honorary consuls and others to perform.

School Admissions

Baroness Sharp of Guildford: asked Her Majesty's Government:
	How they propose to implement their proposals for fair admissions to city academies and trust schools.

Lord Adonis: My Lords, admissions policies for academies are, and will continue to be, agreed by the Secretary of State and must accord with the code of practice to ensure all-ability local admissions. Trust schools will be treated in the same way as other maintained schools are now, with the same requirement to have regard to the code and the same right as other schools and local authorities to refer disputed arrangements to the schools adjudicators for determination.

Baroness Sharp of Guildford: My Lords, I thank the Minister for his reply. Am I right in thinking that the White Paper contains no power to enforce trust schools to introduce banded or fair admissions of any sort, that it is purely a matter of encouraging them to do so, and that there is no intention to introduce legislation to enforce it? If that is the case, does "fair admissions" mean anything at all?

Lord Adonis: My Lords, the noble Baroness is under a misapprehension. The schools adjudicator will have exactly the same power in respect of trust schools: an absolute power to enforce admissions arrangements where they are held to contravene the code of practice, and complaints are made to the adjudicator.

Lord Baker of Dorking: My Lords, I congratulate the Government on reintroducing grant-maintained schools, which I introduced in 1988 and they abolished in 1997. Does the Minister recall that they were so popular that the Prime Minister sent his children to them before he kicked away the ladder? Does he not recognise that he owes an apology to the country for denying a whole generation of schoolchildren the advantages of those schools?

Lord Adonis: My Lords, we have not reintroduced grant-maintained schools in any form. In particular, we have not reintroduced the unfair funding that grant-maintained schools received, in respect of other schools; nor have we reintroduced the 11-plus and the selective admissions that they were allowed to introduce. We have no intention of doing so.

Lord Carter: My Lords, under the proposed admissions policy, what arrangement will be made to ensure that children with special needs are treated fairly?

Lord Adonis: My Lords, they receive preferential treatment at the moment. There is a requirement for schools to admit pupils with special educational needs who are specifically named in the statement in respect of that individual school. We are also giving further priority to looked-after children in admissions to schools, and we will lay before the House regulations that will require schools to make that their first item for admission in their admissions arrangements.

Baroness Walmsley: My Lords, notwithstanding the answer that the noble Lord has just given and what he said to my noble friend Lady Sharp, is he aware of the evidence in the Guardian on Monday that academies are leaving behind children on free school meals? How will the Government ensure that there are levers to make sure that no poor child or child with special needs or a disability will be left behind if, as they hope, all schools turn into trust schools?

Lord Adonis: My Lords, the noble Baroness should not necessarily take at face value everything that she reads in the Guardian. Last September, the 14 academies that led to that report recruited 1,100 pupils eligible for free school meals compared to 980 for their predecessor schools. That is an increase of 12 per cent, so the evidence is that they are increasing not decreasing their outreach to poorer students.

Baroness Buscombe: My Lords, just over a week ago, the Prime Minister said:
	"There should be more advanced classes for the brightest youngsters. And there should be renewed encouragement for setting by subject ability".
	Does the Minister agree with the Prime Minister that, although the White Paper talks about fair admissions and an all-ability intake, once inside the school gates, selection is fine and should be encouraged?

Lord Adonis: My Lords, I always agree with the Prime Minister. He said nothing at all about selection in the form to which the noble Baroness refers. The Prime Minister was talking about proper provision suitable to all children within schools, which is precisely the comprehensive principle that noble Lords on this side of the House support so strongly.

The Lord Bishop of Rochester: My Lords, in view of the strong commitment from these Benches to inclusive admission policies for Church of England schools, will the Minister give the Government's position on interviews prior to admission?

Lord Adonis: My Lords, the code of practice is clear: we do not favour interviews before admission. All but a tiny number of faith schools have given up the practice of interviewing, including virtually all Church of England schools, under the very strong guidance given to them by the Church of England education service.

Lord Northbourne: My Lords, does the noble Lord agree that if the schools are to fulfil their requirements of taking both the greatest possible range of pupils and disadvantaged pupils and of giving all those pupils the support they need, those schools will have to be large? Does he not accept that there are some children for whom large schools are not suitable?

Lord Adonis: My Lords, we do not accept that they need to be larger. That is a matter for the head teacher, governors and local authorities to decide between them. Many smaller schools have excellent reputations in inclusive education, and indeed in special educational needs.

Baroness Howe of Idlicote: My Lords, given that the plan is to give the individual support that the individual child needs, will it be government policy to ensure that the right amount of finance follows those schools where there is the greatest need to give individual attention?

Lord Adonis: My Lords, we have increased real-terms education spending by fully 50 per cent since 1997, so a significant increase in funding is going into our schools. Last week, we announced an additional £300 million specifically for tailored provision in secondary schools.

Lord Pilkington of Oxenford: My Lords, how is it that a school can be itemised as a specialist in, say, modern languages, but not test future pupils in their ability to benefit from modern languages? This is not selection—they do it all over Europe. How does the Minister justify describing a school as a specialist language school when it cannot test its pupils on languages?

Lord Adonis: My Lords, specialist schools cover the entire curriculum but are centres of excellence in a particular area of that curriculum—for example, modern languages, as the noble Lord has just mentioned. That is absolutely compatible with having all-ability admission.

Baroness Buscombe: My Lords, with the leave of the House, following on from the answer the Minister gave me, does he then disagree that on 24 October the Prime Minister said,
	"There should be more advanced classes for the brightest youngsters. And there should be renewed encouragement for setting by subject ability, which has already been extended since 1997"?
	Surely that is not the "one size fits all" comprehensive education that the Prime Minister is referring to?

Lord Adonis: My Lords, those pupils are actually in a school. The selection favoured by the noble Baroness's party would stop them getting into the school in the first place. We are seeking to ensure more tailored provision for all abilities and aptitudes within a school, which is the comprehensive principle.

Lord Roberts of Conwy: My Lords, the noble Lord carefully outlined the dissimilarities between the grant-maintained school and the trust school. Would he now care to give us an analysis of the similarities between the two concepts?

Lord Adonis: My Lords, they are both schools.

Compensation Bill [HL]

Lord Falconer of Thoroton: My Lords, I beg to introduce a Bill to specify certain factors that may be taken into account by a court determining a claim in negligence; and to make provision for the regulation of claims management services. I beg to move that this Bill be now read a first time.
	Moved, That the Bill be now read a first time.—(Lord Falconer of Thoroton.)
	On Question, Bill read a first time, and ordered to be printed.

NHS Redress Bill [HL]

Lord Warner: My Lords, I beg to move that this Bill be now read a second time. It is a Bill for and about patients, and about delivering a better response to patients who have been harmed by their NHS hospital care. It puts patients at the heart of the process. It is about supporting the NHS to learn from mistakes, and making the NHS a safer place to deliver patient care.
	In 2001, the then Secretary of State, Alan Milburn, asked the Chief Medical Officer, Sir Liam Donaldson, to look at reform of the clinical negligence system. This was because the current system was perceived to be complex, unfair and slow. It was seen as costly in legal fees, in diverting clinical staff from delivering care and in its negative effect on NHS staff morale and public confidence in the NHS. It leads to patient dissatisfaction with the lack of explanations, apologies or reassurances that action has been taken to prevent the same incident happening to another patient.
	Perhaps as worrying is the fact that the present arrangements encourage defensiveness and secrecy in the NHS that stand in the way of learning and improvement. In June 2003, Sir Liam published a series of recommendations for reform in his report Making Amends. The Bill gives effect to his recommendation that we should introduce an NHS redress scheme to provide investigations when things go wrong; remedial treatment, rehabilitation and care, where needed; explanations and apologies; and financial compensation in certain circumstances.
	We want to take a radical approach to responding to patients who are unhappy with the healthcare that they have received. The Bill sets out the framework for an NHS redress scheme. The scheme will provide a mechanism for settling claims in tort arising out of hospital treatment, brought by patients, their estate or their dependants. It will provide a mechanism for the swift resolution of low monetary value claims without the need to go to court, covering claims in respect of personal injury or loss arising out of a breach of a duty of care and in consequence of any act or omission of a healthcare professional. Only liabilities in current tort law will be covered by the scheme; the intention is not to create new rights but to improve access to justice for those with rights that exist under current law.
	The scheme is not an end in itself; rather, it is a means to an end. It supports a better response to those patients who have suffered clinical negligence under the care of the NHS. It delivers what patients tell us they want when something goes wrong with their care—an explanation, an apology and things being put right, including coverage of financial losses and financial compensation where appropriate. They want to know that the NHS will work to ensure that what has happened to them does not happen to others. It establishes mechanisms for there to be a response in a positive and open way to patients and their relatives when mistakes are made in the delivery of healthcare. The scheme is intended to facilitate the resolution of cases in a swift manner, ensuring that redress is provided to the patient as quickly as possible.
	The scheme will apply only to cases arising out of hospital care provided or commissioned as part of the health service in England, wherever that hospital care might be provided, regardless of the type of provider or contracting arrangements. The majority of cases of clinical negligence occur in secondary care; it is therefore appropriate for the scheme initially to be implemented in hospital care. I recognise that there are concerns about restricting the freedoms of NHS foundation trusts by requiring them to be members of the scheme, as we intend. However, we believe that patient interest is best served through a level playing field, with all providers participating in the scheme. Those principles have the support of the director of the Foundation Trust Network.
	We do not intend it to be possible for a patient to be compensated twice. Any case that is or already has been the subject of court action—successful or otherwise—will be excluded from the scheme. When a patient accepts an offer under the scheme, he or she will waive the right to bring civil proceedings for the liability to which the settlement relates. If legal action commences during the consideration of a case under the scheme, the case will be excluded from the scheme.
	We envisage that the scheme will be administered locally. To drive culture change, scheme members will need to take ownership both of how they respond when something goes wrong and of the solutions to any shortfalls. Learning from mistakes at a local level will be promoted by a new requirement for scheme members to appoint an appropriate member of staff—for example, a director—with responsibility for overseeing the scheme and learning from mistakes.
	It is intended that the NHS Litigation Authority will monitor the scheme to ensure consistency, support scheme members and provide advice and assistance where needed. We envisage that the NHSLA will determine liability and quantum for cases falling within the scheme and make payments under it. Scheme members will contribute to the costs of running the scheme through financial contributions that will be adjusted to reflect the quality of the risk management processes that each organisation has in place.
	The Bill sets out requirements for organisations to identify cases covered by the scheme while investigating or reviewing cases and to take appropriate action. We intend that all scheme members will be required to trigger the scheme and provide investigations and explanations. In appropriate cases, apologies will be offered and, after consultation with the NHSLA, an offer of financial settlement. Patients or appropriate representatives will also be able to apply to the scheme directly.
	Financial compensation will be broadly equivalent to the level of compensation that would be provided in a successful claim before a court and the offer of redress may include, where appropriate, remedial care. The scheme will cover cases up to a maximum financial limit which will be set out in secondary legislation. It is currently intended that this limit be set initially at £20,000 .
	I note the concerns of the charity Action against Medical Accidents, that to guarantee patient empowerment there needs to be access to specialist independent advice. I should like to reassure your Lordships that to protect patients' interests it is intended that the applicant will be given the opportunity to have the offer of redress independently evaluated by a solicitor without charge to them. It is also intended that where awards are made to vulnerable people such as children or those lacking capacity, they will be subject to approval by the appropriate court to ensure that accepting the offer is in the patient's best interests.
	If an offer is rejected, the patient will retain the right to pursue the matter through the courts. The scheme is not intended to affect the legal rights of the patient.
	The NHS redress scheme is not a cost-saving measure. In the short-term it may increase costs, as access to justice is improved. Costs may be around £48 million in the first year. However, this is a small increase when set in the context of the huge investment the NHS has seen over the past five years with NHS funding rising to around £70 billion in 2004–05. The scheme ensures that money is spent on compensating patients with a genuine claim of clinical negligence rather than on the disproportionate legal costs that come with litigated cases. The scheme's costs will be offset by a saving of around £7.6 million on claimant lawyer costs in the first year alone.
	Where patients are unhappy with the administration of the scheme, the Bill provides for handling complaints about maladministration of the scheme. The Bill broadens the remit of the Health Service Commissioner for England to allow her to investigate complaints relating to maladministration of the scheme and to report on her findings.
	Much of the technical detail of the scheme and how it will be run will be set out in secondary legislation. A delegated powers memorandum and further note providing additional detail on the rationale behind the structure of the powers has been submitted to the Delegated Powers and Regulatory Reform Committee. A statement of policy will also be published before Committee stage which will set out the detail of how the scheme will work in practice.
	It is intended that there will be a single scheme set out in a document that will be scheduled to regulations. The regulations and detail of the scheme will be subject to full parliamentary scrutiny. Specifically, the regulations establishing the scheme will be subject to affirmative resolution procedure. Prior to this, the regulations will be published in draft and a full consultation will be carried out with stakeholders.
	Scotland and Northern Ireland do not currently intend to adopt the NHS redress scheme. The Bill includes a framework power allowing the National Assembly for Wales to make regulations establishing arrangements as to how redress will be provided in Wales.
	Extensive consultation has taken place with stakeholders to develop the policy behind the NHS redress scheme. Its principles have received broad support from a wide range of stakeholders, including representatives from the medical and legal professions, NHS organisations and patient groups. Many organisations acknowledge the need for change and support these reforms as a way to deliver a better response to patients.
	The British Medical Association and Royal College of Nursing have indicated their support for the broad principles behind the Bill. The Patients Association is,
	"encouraged by the Chief Medical Officer's commitment to reform of the present arrangements",
	and the charity Scope has welcomed the scheme as,
	"a clear indication of the determination of the Government to have a more open and fairer NHS".
	The Law Society has expressed support for providing,
	"a package of measures concentrating on access, openness and improving patient safety".
	The NHSLA believes that,
	"the scheme should enable [it] to deliver access to justice even faster and more economically in future",
	and the NHS Confederation welcomes the Bill,
	"if it can succeed in its aim to make the cumbersome compensation process more effective".
	In conclusion, I believe that the NHS Redress Bill will deliver valuable support to patients who have been harmed by their NHS hospital care and provide a focus for better patient care in the future by delivering the mechanisms—and perhaps more important, by supporting the culture change—that is necessary to deliver a better health service. I commend the Bill to the House.

Baroness Carnegy of Lour: My Lords, obviously this Bill is very important to patients, which is why it is a piece of primary legislation. Why are the people of Wales to be deprived of proper discussion in the National Assembly by making this a piece of secondary legislation there?

Lord Warner: My Lords, we are enabling the people of Wales to discuss this issue and to take care of their devolved responsibilities in the way that has been provided for.
	Moved, That the Bill be now read a second time.—(Lord Warner.)

Earl Howe: My Lords, on behalf of all my noble friends on these Benches, I should like to thank the Minister for having introduced the Bill with his customary clarity. It is a Bill which, let me be the first to say, springs from a diagnosis with which very few would take issue. There is surely no doubt that the system which we have at present for dealing with clinical negligence claims against the NHS is fraught with shortcomings. It is slow and it is expensive. Typically, a claim, from the moment it is initiated, takes a very long time, often several years, to reach an outcome. Not infrequently the legal and administrative costs of settling a claim exceed the money actually paid to the claimant. In the last financial year, legal costs accounted for over a quarter of all the money paid out in clinical negligence cases.
	On top of that, the system is widely viewed as being unfair. The main unfairness is that it is only the 10 per cent of the population who are eligible for legal aid, and the very rich, who have access to justice. For many people there is no justice at all because the cost and complexity of making a negligence claim deters them from ever beginning, even though the grievance may be perfectly legitimate. What the Minister did not say, but which he could certainly have added, is that a high proportion of the cases that are taken forward are artificially fuelled by the legal aid system, which creates perverse incentives to lawyers to take on cases regardless of merit and then to drag them out. For claimants on legal aid there is no downside because even if they lose, costs cannot be awarded against them. By exactly the same token, the NHS is in a no-win situation. Even if it successfully defends a case, the costs of doing so are irrecoverable if the claimant is legally aided; and that often means that it is cheaper to settle a case out of court than to contest it, even though the claim may lack any obvious merit.
	The need to reform the system is plain and the Government are to be congratulated on having the political will to try to get to grips with it. I particularly agree with the Minister that more often than not what the aggrieved patient wants is an explanation and an apology for what went wrong. But all too often he gets neither. For the majority of people, making a complaint is not about the money, it is about getting those responsible for a clinical error to acknowledge what went wrong and gaining some reassurance that lessons have been learnt and that the same thing will not happen to someone else. It seems to me that if any sort of new and improved claims system is to be counted a success it is these things, above all, which it must deliver.
	The Minister helpfully charted the journey the Government have made since the commitment in their 2001 manifesto to reform the system. The fact that this journey has been, to put it kindly, something of a rocky road is one which, perhaps understandably, he glossed over. The great cry in the CMO's document Making Amends was the need, as he saw it, to move away from a strictly tort-based system. Now, though, as we read Clause 1 of the Bill, what do we see staring us in the face? There is the phrase "qualifying liability in tort", defining what will constitute a valid claim under the proposed scheme. It looked for a long time as if the Government were going to place a good deal of emphasis on conditional fee agreements as a way of ensuring that only claims with a real chance of success would be taken forward, and spurious claims weeded out. Then, after a great deal of cogitation, we heard from Mr. Lammy last March that the Government's proposals would not, after all, include the idea of conditional fee agreements.
	There were, I believe, 19 recommendations in Making Amends. This Bill embodies the response only to the first of those. Of the rest, the major recommendation—for a no-fault scheme for birth injuries sustained by babies—has, we understand, been dropped and the remaining 17 quietly shelved. So, high marks to the Government for good intentions; but we need to recognise that the Bill before us is not quite the groundbreaker that many of us once believed it would be.
	The objective of the Bill is certainly laudable. It is to create a scheme for speedy, efficient and appropriate redress for patients of the NHS who have suffered harm arising from negligence during the course of their treatment. It is designed to deal with claims of harm at the less serious end of the spectrum, and we know that these currently comprise about 70 per cent of the claims made each year. The great advantage is that the scheme is intended to be an alternative to the complex and expensive process of civil litigation. I do not think anyone would dispute that these are all good and worthy aims.
	What we need to decide, however, is whether the Bill achieves those aims successfully. It is a skeleton Bill. Much of the detail will be the subject of regulations. It is a great pity that we have no draft of the regulations before us that we can consider; but, because we do not, it is a fair bet to say that we shall need to table a goodly number of probing amendments in Committee to try to put some flesh on the bones. There are, however, things that we can surely say in advance of that stage. We hear that it is the Government's intention to give the NHS Litigation Authority the responsibility of running the new scheme. That means that an organisation which—with no disrespect to the excellent people in it—is very much in-house in relation to the NHS is being asked to take charge of the claims process from start to finish. It is being asked to determine the facts underlying the claim; to decide whether there has been an error; to assess the seriousness of any such error and give an explanation of what happened; to determine whether the error constitutes a qualifying liability in tort; and, if it finds that it does, to put a value on the compensation to be offered to the patient. The NHS, in other words, is being required to find fault against itself as judge and jury of its own performance.
	I believe that that inherent conflict of interest represents a serious flaw in the scheme. What we essentially have here is a trade-off. The trade-off is between speed, simplicity and ease of handling and natural justice. I do not believe that that trade-off will command confidence. However diligently the NHSLA does its job, the patient will never be able to have certainty that bias is absent or that he has not, ultimately, been short-changed. The one feature of civil litigation which is surely positive is that it is an independent process. The same really cannot be said of the scheme before us. It will lack credibility.
	Then there is the cost. We see on page 13 of the regulatory impact assessment that:
	"The Redress Scheme may increase spending on compensation payments because it will improve access to justice and thus bring new claims into the system . . . The vast majority of opportunistic claims will be easily rejected".
	I do not know what basis the Government can possibly have for making that last statement. In clinical negligence litigation the success rates are modest. Vast sums of public money can be spent before cases are abandoned. All the experience to date shows that spurious claims are not easily rejected. Indeed, in litigation, nuisance claims are often compensated where the claimant has no risk because it is more expensive to contest the claim than it is to settle. Exactly the same thing is likely to happen here. The redress scheme provides a free ticket for a compensation claim, with no disincentive whatever for claims that are opportunistic.
	We are assured by the Government that the scheme will represent a departure from the adversarial tort-based culture of the courts. Frankly, I do not see that. Where you say to a claimant that he is entitled to free legal assistance to help pursue his claim with the NHS, it is hard to see how this will not replicate the adversarial culture with which we are already so familiar and which Making Amends explicitly sought to avoid.
	But what is particularly unfortunate, in my view, is that the proposals before us focus so strongly on monetary compensation. The essence of Making Amends was that redress should first and foremost be about fact-finding, explanation and apology. In the majority of cases, as we know from patient surveys, that is all that the patient wants. By putting the emphasis on compensation, the proposals in the Bill force us to move those ideas away from centre stage. I think that that is an error.
	If I had to summarise what I felt about the Bill I would say that it was a wasted opportunity. With a little more finesse, the Government could have created a scheme that did all the things that everyone wants and which the scheme before us patently does not. In Committee, I shall be setting out an alternative model. The essence of that model is to separate the process of fact-finding from the process of determining liability.
	The process of fact-finding should be carried out by a body independent of the NHS—perhaps the Healthcare Commission—at the end of which would emerge an explanation, recommendations on lessons learnt and, where appropriate, an apology. The fact-finding exercise may or may not give rise to a qualifying liability in tort. Determining whether it does or does not should not be a function of the NHS. Whether a patient wishes to pursue the compensation route, having received an apology and explanation, will be up to him. But investigating fault and determining damages should be entirely outside the scope of the redress scheme. Those things can be pursued by negotiation, specialist mediation or by a fixed costs arrangement.
	I freely concede that a two-stage model such as this is likely to lengthen the time before compensation is obtained. But it is less likely to short-change the claimant; it is less likely to compensate unworthy claims; it will be independent; and, above all, it will meet patient expectations.
	The scene is set for some interesting debates in Committee, to which I look forward. I could have wished to conclude my remarks by congratulating the Government on a piece of work well done. That I cannot do so is a matter of sincere regret, as I do not doubt that the Minister's heart is in the right place. But if noble Lords are minded to agree with me that these proposals are not well thought through, there may be a chance of persuading the Minister that improvements to the Bill can usefully be made. I very much hope so.

Baroness Neuberger: My Lords, in many ways we must all welcome the NHS Redress Bill. I need to declare a few interests: I was formerly—a long time ago—chair of the Patients Association; I have been a member of the GMC and I have chaired an NHS trust, so I have dealt with some of those issues over a long period of time. Indeed, going back nearly 20 years, AvMA—Action against Medical Accidents, or the Association for Victims of Medical Accidents, as it was then called—had as its chief executive Arnold Simanowitz, who was even then proposing a similar scheme so that we could get away from the adversarial and litigious system that he saw growing in our country.
	More recently we have seen concern about the huge cost of litigation, although that is mostly down to lawyers' costs, and some very large settlements, because the actual number of cases has begun to go down. Most of us would also have broadly welcomed the Chief Medical Officer Sir Liam Donaldson's excellent consultation document, Making Amends, which came out some two years ago. No one thinks that the present system is satisfactory and all of us have concerns that it militates against a culture of openness and frankness between clinicians and patients and between staff more generally and patients. At present it leads to a less than frank approach; and given the understandable reluctance to admit mistakes it is all the more difficult to learn from them.
	If we add to that a growing risk aversion more generally in our society and a failure to accept that things will go wrong in human interactions and that modern medicine is complex and can be dangerous, we seem to have a recipe for a difficult atmosphere between patients and clinicians when things go wrong. Indeed, in my experience staff often prefer to hide mistakes because they are frightened of being blamed within their own organisations for mistakes that have taken place—as they will in normal human interactions.
	Add to that the natural if not wholly acceptable tendency of organisations to be loyal to themselves and staff within them to each other and one can see how it might be difficult for an ordinary patient or patient's relative to obtain a proper explanation or apology when things go wrong—as they do. As an NHS trust chairman in the 1990s I certainly saw that at first hand: people seemed to find great difficulty in admitting mistakes, apologising and explaining what had happened. So all credit to the Government for trying to take on the issue and for realising that the present position is far from satisfactory.
	That having been said, however, like the noble Earl, Lord Howe, we on these Benches feel that the Bill begs more questions than it answers. The Minister will no doubt already have had presented to him by other means many of the issues that I and other noble Lords will raise with him today. He may indeed answer that all our concerns will be dealt with in the detail of regulations, but I have to say that we will not be satisfied with that, any more than the noble Earl, Lord Howe, is satisfied that we have not at least seen draft regulations to examine at this stage. We too think that there may be a large number of probing amendments in Committee.
	However, we are seriously concerned with three separate aspects of the Bill as well as wishing to raise other questions. Like the noble Earl, Lord Howe, we were surprised to see that we have before us a wholly talk-based system, given all the publicity there has been about the system and all the agonising there has been about a talk-based system in the past. The first of our three major concerns, as AvMA and others have rightly pointed out, is that it is essential that any investigation into an adverse incident is truly independent. That is because of the organisational point to which I referred earlier, where those within an organisation, however well intentioned, tend to back their colleagues unless the circumstances are extreme. That is backed up by this week's news from the Healthcare Commission that around one third of NHS complaints are referred back to the organisations concerned. We are not good at dealing with that issue.
	It is also essential that the system has an independent element if the new system is to be one from which doctors, nurses and other health professionals can learn. Only by being held up to an independent view can people truly learn, where there is no question of bias.
	Yet the Bill does not say anything about that. AvMA suggests that the responsibility for investigating and deciding upon cases under the redress scheme should rest with an independent body rather than the NHS Litigation Authority, which is part of the NHS system and which will administer the scheme. That has some attraction, as has its suggestion that the Healthcare Commission would be an obvious candidate, given its role at the independent stage of NHS complaints. The Healthcare Commission also has a much more general monitoring role, so that it could ensure that lessons were properly learnt and absorbed from the incidents dealt with by the redress scheme.
	Even if the Government do not want to go that far, they should certainly be emulating in the Bill what has already happened in the current Welsh speedy resolution scheme and in the Resolve pilot scheme which took place a couple of years ago, a fast-track resolution scheme for smaller claims. In both schemes, the judgment as to whether compensation should be awarded was made by an independent medical expert, agreed by the NHS and the claimant together. Independence is the first main question. We would also like to know why AvMA and other members of the Clinical Disputes Forum were told that the redress scheme would be run like the Resolve and Welsh schemes, and why that now appears not to be the case.
	Secondly, there is the major question of the dropping of the duty of candour, which was such a key feature of Sir Liam Donaldson's consultation paper. Yet at least half the thinking behind the desire to go for a redress scheme such as this was to encourage openness and candour, as the National Patient Safety Agency's policy seems to suggest, as the GMC's good medical practice guidelines insist, and it has also been warmly welcomed by the Healthcare Commission. Yet that duty of candour is not mentioned in the Bill, despite it being key to the National Patient Safety Agency's thinking and despite the fact that this whole approach rests upon a desire to move away from an adversarial and less than frank approach to an open one of trust between clinician and patient where redress, when things have gone wrong, can be swift and simple.
	Thirdly—and this point has already been raised by the noble Earl, Lord Howe, and the Minister himself—the scheme appears to be limited to hospital care, despite signals from the Minister that it may eventually be extended. Yet it is clear that the vast bulk of care is provided by primary care. At present, if patients are damaged by negligence in primary care, they have to sue their GPs individually, as contractors to the NHS. That makes no sense, given the changing shape of primary care, the vast increase in care in the community, especially for chronic conditions, and it makes it difficult for both patients and GPs. Patients often know and like their GP, yet they may have been damaged by care received within the primary care system. Meanwhile, GPs are paying large premiums for indemnity cover. It is hardly satisfactory.
	There are many more questions, perhaps not of such great importance, that the Minister may be able to clarify in his response. First, what happens when it is not a case of individual negligence but system failure, arguably organisational negligence? Will the scheme cover that, and will the NHS be able to learn from it thereby? Secondly, are there any rights of appeal against a decision of the litigation authority, or does a dissatisfied claimant simply have to go to the courts, as now? If that is the case, will it not militate against openness in the system? Thirdly, who will monitor the scheme to see that it is carried out fairly—if the NHS is investigating itself—and that the NHS learns from these errors and that systems are put in place to help NHS organisations learn openly from things that go wrong? Fourthly, how will claimants be advised? Will they be able to get access to independent specialist representation and paid for beyond the solicitor who will be paid for at the time that an offer is made by the litigation authority? If not, how will this be seen as truly involving the patient as an equal, especially if the investigation is being carried out by the organisation which has been challenged and complained against?
	Few patients have the expertise to ask the right questions at the right time. Nor would they necessarily understand how judgments are made, such as by the Bolam test where it is not the "highest expert skill" that is the test but the standard of the "ordinary skilled man". One has to be technically reasonably competent to get one's head around that.
	Fifthly, although the Government have not gone for a no-fault compensation scheme—a system favoured by these Benches—the Scottish experience with the Macfarlane trust for HIV-infected people from blood products is one where people receiving payments waived their right to litigate and the Government were excluded from liability. Did the Government consider the advantages in terms of openness and less defensive practice—a contrast with the US-style practice about which the Chief Medical Officer is so worried of a no-fault system? And, if they did, and rejected it, how does the Minister think that this system will truly promote openness, when practitioners will still be concerned about being found negligent?
	How does this present Bill relate to the Swedish no-fault system, where successful claims are those that compensate for injuries unexpected by the patient and unforeseeable or impossible for physicians to avoid—in other words, the practitioner is not found to be at fault, but injuries worthy of compensation are compensated? There appears to be no similar provision in this Bill. Such a provision would give clinicians some comfort—they would not be seen to be negligent.
	Lastly, this Bill seeks to deal with relatively small claims and the Secretary of State can cap the amounts, yet the real cost of settlements comes from severely damaged babies at birth and from legal costs. To what extent will capped settlements mean that prospective claimants will choose not to use the scheme, but instead go to claims farmers operating on contingency fees? Even if legal aid will not be freely available—clearly it will not be—will a low cap not make it likely that lawyers will operate on a contingency fee basis and claimants go through the courts as at present so that the hoped-for reduction in litigation will not necessarily take place, health professionals' fears of litigation will not be reduced and the whole aim of openness and learning from mistakes will simply not be realised because the cap may be set too low?
	In conclusion, in principle we are delighted to see this legislation. But at present there are too many unanswered questions—I have given the Minister a few—and too many concerns of principle for people on these Benches to give it their unqualified support. Like the noble Earl, Lord Howe, we also think that this is a wasted opportunity.

Baroness Murphy: My Lords, what is proposed in this welcome enabling Bill has the potential to do much more than at first appears. I support this Bill: it will help to improve the culture of responsiveness to complaints in the NHS. I declare a personal interest as chair of a strategic health authority in London which last year spent over £26 million on compensation claims and legal costs through the NHS Litigation Authority schemes for trusts on our patch.
	The NHS Litigation Authority has done a terrific job in my view over the past years to bring down the number of new claims. After all, that is what we hoped it would do. However, the amount awarded by the courts for the more serious cases has gone up and so have legal costs—quite dramatically in some cases and possibly unjustifiably. As Ron Bradshaw, the chair of the authority has remarked, the authority and insurers, when paying legal fees, are like those paying a taxi fare for a driver who is choosing the route, at a rate that he would like to be paid, for a passenger—the claimant—who is totally disinterested in the fare because they will not be paying. Compensation culture has become legal vulture culture in many instances.
	Thirty-eight per cent of claims are abandoned, 43 per cent are settled out of court, usually in favour of the patient, just less than 2 per cent are settled in court in favour of the patient and an even tinier percentage, 0.5 per cent, are settled in court in favour of the NHS—the last two instances at quite phenomenal cost. Even going as speedily as they can, the whole process takes on average about one year and four months.
	This Bill is designed to address that multitude of smaller claims that at present not only often take just as long for the patient to get settled but are at the heart of a disastrously defensive NHS culture of avoiding blame at all costs. I do not know whether noble Lords have ever been in receipt of an NHS response to a complaint letter, but I have seen dozens. I usually see them five or six months down the line when it is too late to say, "Oh dear". They make me cringe with embarrassment. They are couched in something like:
	"We are sorry you felt the need to complain about your perception that",
	followed by a list of what they think is wrong. They are awful. There is rarely a straight apology that something has gone wrong and never an honest, open explanation. Given that, importantly, there is no opportunity for the clinical service to learn from mistakes to prevent the thing happening again. An escalation of patient and family resentment follows; positions become entrenched; and while legal action is being pursued there is every likelihood that the patient's physical and psychological recovery from the mistake will be delayed. We see that time and again. People could get back to work but their return to work is delayed because they are waiting for some compensation claim to be settled.
	The National Patient Safety Agency has put in a first-rate confidential incident reporting system to encourage clinicians to be honest about accidents, mistakes and near misses. It aims to end the blame culture, but unless we change the redress culture, too, its efforts will not yield fruit.
	If I have a concern, it is about the duty of co-operation between the NHS Litigation Authority, the NPSA and the Healthcare Commission outlined in Clause 13. At present the NPSA operates with the full confidence of the clinical professions and the NHS management because they know that they can turn to it in absolute confidence. I should like reassurance that there will be no obligatory information sharing, even of anonymised data, if in the NPSA's judgment that would be detrimental to its role in allowing clinicians to speak in confidence.
	The scheme is attractive because it provides a more proactive approach to clinical negligence with the onus no longer on the patient to initiate a claim but a duty on the service to initiate an intervention. All scheme members—trusts—will be required to review adverse incidents themselves, where appropriate. I want reassurance on how the schemes will be triggered. I am still rather puzzled as to how it will work in practice. If the patient does not initiate a request, who does? If the patient cannot, who can? If the clinical service initiates it, there is scope for major under-reporting. I need to know more about the practicalities of the scheme.
	I am disappointed, as I had hoped that the Bill would ensure speedy assistance to children with severe neurological birth injuries so that parents could receive a support package as well as financial help as quickly as possible. That would be a major advance and simplification of the legal wrangles that have to be negotiated, and would give practical help at a time of enormous distress. I wonder what happened to that—so many of us were hoping that it would be alongside the low compensation qualifying amount scheme.
	Overall the aim of the scheme is to ensure that NHS money goes directly to benefit patients and to provide appropriate, speedy redress, with less spent on legal costs. Of the £26 million spent in my area, two-thirds was paid out, properly, in damages to patients, and about one-third—nearly £9 million—was spent on legal fees. That would fund an awful lot of hip replacements or cancer treatments.
	Everyone to whom I have spoken in the NHS supports the Bill. Although I am sure that there are many ways in which it could be improved to ensure that patients feel that it is a fair and ready way for them to get the compensation they need, I wish it a speedy passage and hope that it will be very much supported by Members of this House.

Baroness Morgan of Drefelin: My Lords, I welcome the introduction of the Bill. As one of the signatories of the NHS Plan back in 2000, as was the noble Baroness, Lady Neuberger, when the initiative was first trailed, I am pleased that we are debating the principles of the new scheme today.
	I shall focus for a moment on why the Bill represents an important step forward for patients, and I make a plea that when we get into the detail we do not lose sight of that. Yes, in recent years it has been widely recognised that the NHS does not respond well when things go wrong. It has been a fight for patient organisations to get to that place. In some cases when things have gone wrong, the NHS has literally added insult to injury. We have heard already that health professionals can close ranks and become defensive; but we know also that, depending on the severity of the wrong, most patients would consider an apology and the knowledge that their experience would not be replicated for others to be an appropriate response, and that only a minority of patients who experience the most serious mistakes or wrongs would like to go on to seek financial compensation.
	We know that when things go seriously wrong, patients have little alternative but to go through the legal system; and while most cases are settled out of court, pursuing those cases can be extremely time-consuming and a distressing experience for all. As we have heard, the NHS Litigation Authority reports that 60 to 70 per cent of claims do not proceed past initial contact with a solicitor or disclosure of medical records, and 95 per cent are settled out of court. Let us think about the people behind those numbers. I am particularly concerned that more should be done to eradicate the unnecessary suffering of patients, their families and the carers whom that statistic represents. We need to do much more to change the situation—and noble Lords should remember that some cases can take up to 10 years to settle.
	There is a very strong case to be made for a redress scheme that would provide a real alternative to litigation and which is fair and accessible. Very importantly, the scheme should promote a speedy resolution and improved patient experience when things go wrong. It is essential that such a scheme should create a new openness about mistakes and should contribute to a cultural change, away from defensiveness and secrecy—a cultural change that is vital if lessons are to be learned from mistakes, as we have already heard today. Most importantly, it is essential that the scheme is made as accessible and effective as possible for patients; otherwise, those who can will continue to litigate, with all the costs and distress associated with that.
	Key to that success is the principle of access for patients to free, independent, specialist medico-legal advice. The scheme proposes that that should be made available to all, and I think that is an extremely important principle; but I am concerned about the timing of the advice, and that access to independent advice might be too limited if it remained at the end of the process—at the "take it or leave it" stage. I am particularly concerned that while any offer may be made without prejudice for the scheme member trust, participation in the scheme for patients who may at a later stage go on to require legal aid, should they decide to decline an offer, could prejudice their legal aid, because their refusal of an offer might be viewed as unreasonable by the Legal Services Commission. Therefore, that particular group of patients will need to have their interests protected by accessing legal advice before entering into the scheme. I do not believe that that is intended as the scheme stands.
	That brings me on to the question of who initiates the scheme. I, too, believe that the tenor of the scheme is proactive, and that is a very important principle. I am pleased to see that trusts as well as patients would be expected to initiate the scheme when they see a wrong done, but that must be with patient consent because it is only patients who can assess whether participation in the redress scheme is in their interests.
	I am very pleased that remedial care will represent an integral part of the scheme. All too often the current adversarial system conspires against the establishment of appropriate care packages. When accidents happen, lines of communication between healthcare professionals and patients can break down and it can lead to needs going unmet.
	As has already been said, the Bill does not contain much detail about the operation of the scheme, and much will be defined in secondary legislation. Therefore, I am particularly keen that we should explore with the Minister more of the thinking behind the scheme to obtain an indication of what we might expect to see in regulations.
	For example, I am interested to know more about the £20,000 ceiling. Will that act as a deterrent to the success of the scheme? I do not know. What will be the process of review in three years' time? What will be the success criteria? How will the assessment of the appropriateness of the expansion of the scheme into primary care be made, especially as we are now seeing government policy move ever faster towards the provision of hospital services out of the hospital setting? I am interested to hear more about whether there will be convoluted or complex definitions of a hospital service, regardless of its location. I am pleased that the scheme aims to be speedy and to place time limits on the various stages, but I am concerned that in the interests of speed we should not place a restrictive time limitation on a patient's right to apply to the scheme. What is envisaged?
	There is a strong desire for the redress scheme to be handled locally and to dovetail with the new complaints procedure, which is vital. But only this week, as we have already heard, there have been reports from the Healthcare Commission that trusts are not dealing with complaints as well as they could be. There may be some real issues about how practical it will be for trusts to manage the scheme effectively at a local level. We have heard that trusts will be seen by many to be acting as judge and jury for their own mistakes, so we need to be confident that the new redress scheme can operate in a fair way for patients.
	There has been much consultation in preparing the scheme, and I understand that the legal profession and the healthcare professionals' organisations are supportive—as are patients' organisations. There are concerns and I am sure that we will be able to debate them further. For example, I was particularly interested to hear concerns from mental health charities about the Bolam test, where there is quite a wide spectrum of usual practice and there will be some interesting matters to discuss in relation to it. There are also real concerns about the independence of the scheme.
	I understand that the Minister will not have time today to respond to all my points, so I look forward to having his responses in due course. The aim of the new scheme is to increase access to justice and I fully support that. I very much hope that we will be able to make the most of the opportunity that the scheme represents. I hope that it will lend dignity where often there is none, and help to create a National Health Service that is open and learning, a service where there is rarely a need for patients to litigate, because the caring principles of our patient-centred NHS will prevail, even when things go wrong.

Lord Colwyn: My Lords, we are already half way through the list of speakers. Every point that could possibly have been made has been made—certainly every point that I intended to make has been made. I feel rather sorry for the speakers who will follow me. However, I hope that your Lordships will allow me to emphasise one or two of the points that have been made.
	Any legislation that will allow patients who have suffered adverse incidents in NHS hospitals to avoid the complex legal process and to claim redress in the form of an apology, explanation, further remedial treatment and some financial compensation has to be welcomed. The current system is complex and unfair and suffers from all the defects that have been explained by the Minister and listed in the Explanatory Notes and the various briefings that we have all received. That has been very adequately covered by previous speakers.
	The medical and dental professions are supportive of the initiative and I know that the defence organisations—I declare an interest as a member of the Medical Protection Society, a past member of the council of the Medical Protection Society and a past chairman of Dental Protection—are in favour of a move away from purely financial compensation towards a more comprehensive package of redress. I know that the other dental Peer, my noble friend Lady Gardner, is also in favour of the Bill. She says that she feels that many hospital disputes will be resolved far more easily under this proposed process.
	The absence of the threat of litigation will, it is hoped, create a culture of openness within the NHS in which lessons can be learnt and risks reduced. It should ensure much greater frankness in explaining the nature and cause of any mishap and move us away from the present culture, which prevents health professionals being open about mistakes and learning from them.
	I hope that the Minister will be able to assure the House that this legislation will go some way towards discouraging the increasing national culture of the need to complain—the need to find someone to blame; of no win, no fee litigation. A constant awareness of this threat cannot benefit the NHS, where 99.99 per cent of healthcare workers carry out their duties to the best of their ability and maintain high standards of care. Is it the Government's intention to continue to measure standard of care by the Bolam test, as already mentioned by the noble Baronesses, Lady Neuberger and Lady Morgan?
	However, some aspects of the Bill require clarification—in particular, the need to avoid doctors and healthcare professionals being unfairly criticised. The provision of accessible and appropriate redress for patients in a timely and efficient manner, avoiding the need to resort to lengthy litigation cases, would benefit both patients and professionals. It is important that the redress scheme balances quick resolution with thorough investigation. There must be a careful examination of the facts. Any investigation that fails to consider all aspects of the care provided could lead to doctors and other healthcare professionals being unfairly criticised. That might lead to further investigations and disciplinary hearings that could undermine the morale of healthcare professionals, negating one of the core objectives of the redress scheme.
	The Bill contains little detail, and much of the substance will be determined by secondary legislation. While I understand the need for flexibility to accommodate experience in changing NHS practice, the operational details must be subject to more rigorous scrutiny. Important practical matters, such as raising the qualifying monetary cap for claims, the composition of adjudication panels, the instruction and role of medical experts, the nature of guidance on assessing and awarding compensation, and the appeals process, have not been outlined and will be determined by secondary legislation and by the prerogative of the Secretary of State. I welcome the Bill and look forward to dealing with the detail in due course.

Baroness Tonge: My Lords, I hope that I have some fresh points to make. When I was still working in the National Health Service in 1991, I remember Rosie Barnes, the SDP Member of Parliament in the other place, introducing a Bill for no-fault compensation for health service patients. I have watched with interest as successive governments have tried to deal with this problem. Like the noble Baroness, Lady Murphy, when I was a Member of Parliament I certainly saw those awful letters in response to complaints from my constituents. I noted that the majority of patients give up in despair under the current complaints system and simply cannot face the legal fees or the stress of litigation. Therefore, of course I welcome the Government's attempts to address the problem, but I have many areas of concern.
	First, I was discomforted to read the press release put out by the Minister, Jane Kennedy, in which she talked about medical negligence. In fact, she referred only to "negligence". I felt that that was rather an affront to the majority of hard-working health professionals in the National Health Service. Mistakes are not necessarily negligence; they can be made by doctors as well as accountants and other professionals, and she should have acknowledged that. Those mistakes, or errors of judgment, can be due to fatigue, often brought on by the need to achieve the targets of which the Government are so fond.
	The Minister smiles, but as one who has tried to achieve those targets and lives with someone who is still trying to achieve them, I know what I am talking about. A safe health professional is a relaxed and unhurried one who can spend all the time that is needed to explain to patients their diagnosis and treatment, not someone who is conscious of a bulging waiting room outside and a manager looming with a clipboard around the corner.
	A culture of defensiveness has developed in the health service, so that health professionals are unable to be totally frank with patients when an error occurs, as other noble Lords have said, because of the fear of litigation. As the noble Earl, Lord Howe, said, what patients really want is an explanation and an apology. It is as simple as that. I therefore hope that the Bill will help to dispel that culture. But it is difficult to know because in nearly every clause there is a reference to the Secretary of State making regulations. As many noble Lords have said, the secondary legislation is all-important but we do not know what it is. Perhaps the Minister will tell us when the regulations are due to be published, so that we can adequately address them in Committee. Otherwise, how can we effectively amend the Bill?
	I have several questions as a consequence. We are told that trusts will be registered under the scheme, which will be overseen by the National Health Service Litigation Authority and operated by current complaints departments in hospitals. There is no independence there for the patient. How will the complaints department have the expertise to perform what is a medico-legal process? Will it mean more non-clinical staff—managers, in common parlance—to investigate clinical mistakes and a larger NHSLA to oversee them? Reports made by complaints managers at present are often lacking in clinical veracity and have to be rewritten by overburdened clinical staff, which wastes more of their time and puts more pressure on them. We need to know how this will operate in practice.
	Will the low level of claims suggested—under £20,000—encourage people to try to get a few thousand pounds out of the NHS? It will cost them nothing to try. What estimate has been made of the cost of that and will it really reduce the current litigation bill, which is generally made up of much larger claims? I understand that there is a duty on scheme members to appoint a person to learn from mistakes. I find it quite extraordinary that that had to be in the Bill. Do people in the NHS not already learn from mistakes? Are we suggesting that more staff should be employed to consider mistakes and how they have been made? When I was in the NHS, I spent many hours considering mistakes and drawing up and revising protocols that drove doctors and nurses nearly mad. Surely we are doing this already and, if not, why not?

Lord Warner: My Lords, has the noble Baroness looked at the National Patient Safety Agency website on mistakes made within the NHS?

Baroness Tonge: My Lords, I regret to say that I have not, but I am appalled if we in the health service are not learning from mistakes already. That suggests that we may need to employ a whole army of people to consider those mistakes and ensure that they are not made again. Has that cost being taken into account? If patients can receive redress in the form of care, who will perform the assessment? Will it be those who currently assess people for social care, care at home, care in the community, or whatever? Who will do that and will that be an extra cost to the scheme?
	The area which concerns me most, however, is the definition of "negligence", "a mistake" and "an error of judgment". Who will draw up the list for the Secretary of State of things that can be considered mistakes? What if a whole chain of command is involved, as it often is in the heath service? Whose fault is it if a doctor gives a patient a drug to which they are allergic because the patient's notes have been lost? Who lost the notes?
	I wonder whether the dreaded MRSA infection will be on the list of mistakes and negligence in the NHS. As far as I am concerned, MRSA is certainly due to negligence by the health service. Whether it is by over-prescribing by medical professionals, lack of personal hygiene among nursing staff or incompetence of managers and the cleaning contracts which they have set up, I know that Florence Nightingale must be turning in her grave when she looks at the current state of the health service. MRSA infection is a disgrace. Will every patient who contracts it be able to claim under this scheme?
	There are many more questions I would like to ask, but I await the Minister's response and, of course, the crucially important secondary legislation.

Baroness Finlay of Llandaff: My Lords, the Bill is an important step forward in ensuring that there is reasonable compensation for patients when things go wrong. That is the point upon which I want to focus—when things go wrong.
	The Minister, in his helpful opening remarks, spoke of the framework powers for Wales. I hope that consideration will be given in negotiations on the way in which the Bill will work in practice in England towards negotiating and discussing with Wales as well. There are patients who cross the border. Cross-boundary flows are the one area where patients may get caught, because clinical conditions are very complex. It may be difficult to know to which side of the England/Wales border the error might be ascribed and blame apportioned.
	Access to the scheme depends on a tort that would be otherwise actionable. How do we know when things go wrong, however? Currently, in courts, the Bolam test is applied, to ask whether the treatment was in acceptance and accordance with current medical practice. To answer this question, there is a peer review process—from someone with the scientific knowledge and clinical expertise to give truly informed comment—and a judgment is made. We are all aware of some notable failings of the expert witness system. They have been principally in relation to criminal conviction, however. It is a real problem for any system of review to know just what should, or should not, have been done.
	Medicine is now so specialised that without reference to expert opinion consistency of outcome will not be achieved. Indeed, the very foundation on which a judgment is made will be flawed. It will not be possible to have expertise in all the details of all the conditions. Some of them will be absolutely crucial to the case in hand, details which will prove or disprove negligent care. Without sound information, my concern is that inappropriate and inconsistent payments will be made. While the intention behind the Bill is excellent, it may stack up some problems if we abandon the Bolam test.
	The Bill anticipates that the Bolam test will remain. I hope the Minister will be able to reassure me on that. It would be better if the Bill explicitly stated that the redress scheme will apply only where it can be shown that the care is inadequate as judged by accepted medical practice. We are talking not about the lowest common denominator, but about a standard which is accepted as good.
	A different robust standard to the Bolam principle has not been found. Unless we use the Bolam principle, what will happen? There is, of course, a risk that people will claim that things should have been done based on anecdote, Internet website findings or whatever, but that those interventions which they claim should have happened would not be recognised as evidence-based clinical practice.
	The difficulty is that, when we look at evidence-based practice, most of the time we are looking not only at the situation of one disease and one intervention but also at complex human beings with multiple pathology and different psychological states, all of which can affect outcome. How all those interact will determine ultimately whether care was reasonable and up to standard or whether it was substandard.
	Under the NHS redress scheme, there will be inherent criticism of the NHS professionals involved in the award of a payment. If a payment is made because the care is unsatisfactory, the system must have failed—it may have been the team, a managerial system or a central policy rather than an individual.
	The claimant lobby may be trying to find another standard. It is in their interest to get the maximum compensation out of the system, and it is right that they should keep up the pressure for it. But if the compensation threshold is lower, it will be set by a person's unrealistic expectations to fly in the face of what the NHS can offer rather than realistic expectations that take into account co-morbidity and other incidental factors.
	Co-morbidity is the most important factor in determining poor outcomes, yet sadly it is rarely recognised by the claimant. Clinicians cannot be held responsible for the presence of co-morbidity before patients presented themselves but they must take it into account. They cannot always predict its detrimental effect. The difficulty in clinical practice is that doing nothing can have adverse consequences and may be more dangerous than attempting to do something, so each clinical decision is taken on a balance of risks. When those risks are finely balanced, the inexact science of human disease behaviour can tip the scales so easily the wrong way. Why do some people resist infection yet others succumb? The NHS cannot be held responsible for the inherent genetic factors in the spectrum of the "normal population". Such variation in the "normal" is not clinical negligence.
	What happens if the service is unusually stretched for some reason? In a major incident, for example, the staff and the system have to deal with that incident so other patients may have their care delivered differently. If the incident goes on for some time, some patients may get less effective care than they otherwise would—for example, a delay in diagnosis—but that must be taken into consideration in a fair scheme of redress.
	What of the difficult presentation of a serious situation? Let us take subarachnoid haemorrhage as an example. A patient has a warning bleed and attends accident and emergency with a terrible headache. A full history is taken, the patient is properly examined and is told that she has migraine because the story fits that diagnosis. She appears to recover and goes home but then has a catastrophic bleed. Not every patient who presents with a headache can have a head scan. If the patient had not recovered in the interim or the symptoms had not fitted a migraine picture, further investigation would have been indicated and warranted. Using the "stands to reason" argument, it would be suggested that the diagnosis should have been earlier and that there may not have been sufficient information to warrant such a rapid diagnosis of migraine. But when a typical situation is presented, you can see how that diagnosis was assumed and made.
	The redress scheme may award compensation but without a robust determination of the facts the scheme risks handing out money as sympathy rather than true redress. It is usually not the NHS's fault that someone is ill or that someone's disease does not respond to treatment, and the nature of disease and its course is not an exact science—as a clinician, I dearly wish it were. But it is appropriate that, using the Bolam test, every patient should have the best possible treatment within the resources available.
	The NHS system cannot investigate every possibility of every case, but I hope the system will operate reasonably against an accepted standard, and I urge the Minister to use the Bolam principle.

Lord Parekh: My Lords, I welcome this long overdue NHS Redress Bill, whose advantages seem to me to be obvious. It reduces legal costs. In 2004–05, the cost of clinical negligence was about £503 million, of which £150 million—just under a third—went on legal costs. The smaller the claim, the larger was the percentage of legal costs.
	The Bill should also avoid complicated complaints procedures, which on average take about a year and a half, and sometimes go on as long as 10 years. It should also provide access to medical justice. Last year, I am told, around 800,000 adverse events relating to the NHS occurred. Only a tiny percentage—about 6,000 complaints—involved litigation and compensation payments. This seems to suggest that a large number of people who have suffered from medical negligence are deterred from complaining for all kinds of reasons, and the proposed scheme should be able to remove some of these.
	I like the idea that the scheme is proactive, and the onus is no longer on the patient. This should be of particular help to the poor and ethnic minorities, who are not familiar with the system of complaint and litigation that may be available to them and therefore do not take advantage of it.
	While I endorse the Bill for these and other reasons, I have a few questions. Some are straightforward and simple, others a little more complex. First, I am not clear whether the figure of £20,000 includes remedial treatment. If it does, compensation is likely to be very little and the limit needs to be raised. Secondly, how do we ensure that the remedial treatment is adequate and suitably monitored? Thirdly, this Bill would cover only a small percentage of claims. I am told that last year only 5 per cent of the claims involved amounts of around £20,000. It would therefore be useful to monitor the scheme to see how it works and, if it works well, to find ways of extending it to claims involving larger amounts of money.
	I have difficulty with the NHS Litigation Authority. The noble Earl, Lord Howe, and the noble Baroness, Lady Neuberger, raised this question, and I want to repeat the point they made. I am not entirely sure that the authority can be both prosecutor and judge. It is bound to be seen as in some sense loaded in favour of the medical staff against whom the complaint is made. We must find some way of ensuring that the two functions are separated. I am also not entirely sure how the authority is to be composed. Will it include a larger percentage of lay members than it has so far? What about ethnic minorities?
	My next point concerns the mechanism to ensure that information on mistakes made in one hospital or NHS trust is circulated widely so that it does not remain confined merely to the hospital concerned. Perhaps we should have a national register of mistakes that have been made. It is also important to have a record of good practices, and to see that they are duly disseminated throughout the country, and not limited to the organisation concerned.
	This final point interests me enormously. The Bill is said, rightly, to have been designed not merely to deal with small complaints, but also to change the NHS culture, and to alter profoundly patients' experience of the NHS. Although the Bill makes some progress in that direction, I do not think it goes as far as it could and should. A MORI poll conducted on behalf of the Department of Health revealed statistics that are a great compliment to our country, and to the culture that prevails. Only 11 per cent of complainants were interested in financial compensation. In the case of severe damage, the percentage was no higher than 15 per cent. The figures for the United States are between 75 per cent and 85 per cent. Some 34 per cent of complainants were happy simply with an apology; 23 per cent wanted an inquiry, to avoid a reputation of negligence for themselves or others; and 16 per cent wanted support in coping with the consequences of negligence. That would seem to suggest that nearly 73 per cent of our people have no interest in financial compensation.
	That raises some interesting questions. How do we ensure that that culture is sustained and does not become a culture of complaint or compensation? It is not just a question of identifying pockets of negligence and dealing with them; we need a profound transformation of the way in which the NHS functions. We need more openness. Often, consultants take decisions that are not explained to the patients. Like many Members of your Lordships' House, I could cite cases in which a consultant has diagnosed a patient in a particular way and the patient has screamed, "Look, your diagnosis doesn't make sense. It does not fit in with my history" and still the diagnosis is registered on the patient's file.
	We also need greater humility on the part of doctors. It is important to bear in mind that some cases of negligence can be attributed directly to the medical staff, while others are the complex product of the system in which decisions are taken. It is important, therefore, not merely to think in terms of identifying pockets of negligence among particular members of staff but to consider the system as a whole and ensure that there are clear rules about how medical decisions are taken.
	There have been cases—I could have cited several—in which, for example, surgery was ordered by a junior doctor, even though the patient was not satisfied that the case warranted surgery, the patient has asked to see a senior registrar, and the registrar has reversed the decision of the junior doctor. If the patient had not had the confidence in himself and the courage to ask for a second opinion, he would have been subjected to the surgery and would either have wasted a large number of days suffering the consequences of it or would have made a request for compensation. The example suggests that, often, in some of the hospitals with which I am familiar, the rules on who is entitled to order surgery and whether—especially in the case of patients who are admitted at the end of the day—surgery can be ordered by a junior doctor or must be approved by a senior consultant are not clear.
	For those and other reasons, although I welcome the Bill wholeheartedly, I suggest that there are some loose ends that need to be tightened up. I hope that, in Committee, the Minister will explain why those changes should not be made or will be gracious enough to incorporate them into the Bill.

Lord Turnberg: My Lords, I must apologise even more than usual for the sound of my voice this evening. It appears to have broken for the second time in my life. At least, that has the merit that I will probably not be able to go on for too long. I assure my noble friend the Minister that I am not after his sympathy; I only want him to listen to me.
	I am very supportive of the Bill. The motive behind it—trying to provide accessible and appropriate redress for patients in a timely and efficient way, avoiding the necessity to resort to lengthy and expensive litigation—is welcome and should benefit patients and healthcare professionals alike. I strongly support it.
	I should declare my interest as president of the Medical Protection Society, a not-for-profit discretionary mutual organisation that provides our members, who represent over half the medical and dental professions in the UK, with indemnity, legal advice and assistance for matters arising from their practice. We run education and risk management programmes that aim to improve patient safety and reduce the number of reasons for complaint. It is clear, then, why the MPS is in favour of speedy and fair resolution of the types of problem outlined in the Bill.
	The Bill is unfortunately lacking in detail about how the scheme will be operated, leaving much of that to secondary legislation, as many noble Lords have said. That makes it very difficult to get a grip on the all important detail. That is all the more reason why it would be helpful if the Minister could give us some reassurance now on one or two important points.
	First, it is clear that the Bill is not a no-fault compensation Bill. Like other noble Lords—the noble Baroness, Lady Neuberger, mentioned the issue—I like the idea of that type of compensation for a patient who has suffered some adverse effect from treatment, where no one is at fault, and no blame is to be attached. The Bill is for patients who have suffered because someone has been at fault. That means that someone else has to make a judgment about whether a complaint by a patient that they have been treated wrongly is justified. Was the treatment or management wrong or below acceptable standards? Should he receive compensation and an apology? I always taught my medical students and junior staff that expressing regret when a patient had suffered—expressing concern and empathy—whether or not one was at fault should be part of the culture. Not admitting liability where one is not liable is, of course, important; but one can surely express regret that a patient has suffered.
	Is it correct that the NHSLA will be responsible for the making of that judgment? Will it set up a system for that assessment? That is a concern. Other noble Lords have talked about the problem of the NHS appearing to make the judgment. I have concerns that the litigation authority may make speedy judgments because that is cheaper than doing it in any other way. It is vital that we balance a quick resolution, which is highly desirable, with a fair and thorough investigation of the complaint. At present when a medical professional has to defend himself in court against a complaint he leans heavily on the Bolam principle which compares what the doctor in question did with what would be regarded as normal medical practice. Did what the doctor did fit within the range of acceptable practice as judged by a respected body of experts in that field? If the practice was normal then it cannot be held that there was an error and fault cannot be claimed, even though a patient may have suffered; and that is the problem. That is why I like the idea of no-fault compensation.
	However, we are not talking about that today. The point about this is that when an assessment about a complaint is being made, if it is to be fair it is essential that expert advice about the specific area of medical practice is available to the judging panel. The Bolam principle should be applied; hence the need for the input of an informed body of professional opinion. The Bill provides no detail on how judgments will be reached on complaints, who will make the assessments and to what advice they will have access. Can my noble friend give us any clues on that and any reassurance on the thoroughness with which complaints will be assessed? I hope that he will not say that this will have to wait and all will be revealed in due course. However, if he does, perhaps he will at least tell us that there will be an obligation on the Secretary of State to consult all stakeholders on the future regulations and on such important matters as the composition of adjudication panels, the role of medical experts, the nature of guidance on assessing and awarding compensation and the appeals process.
	I am also concerned that primary care is omitted from the Bill. Is there any chance that primary care may be included at some point? The Bill is welcome but, as always, a little more detail about how it may work would be extremely helpful.

Baroness Barker: My Lords, I take to heart the comments made by the noble Lord, Lord Colwyn, about points already raised. Eight out of the nine speakers before me have asked similar questions. Perhaps I may add more to the list.
	We learn a lot about a Bill from its advent. The advent of this Bill has been both strange and telling. After First Reading it received a fair amount of sympathetic publicity—and then nothing. There was a deafening silence. Until late last week Members of the House were receiving a flood of detailed briefing, all of which has been supportive of the principle behind the Bill and all containing a range of questions from people with a degree of expertise in this field. That has set the tone of our debate. Our bizarre job over the next few weeks will be to encourage the Minister to demystify an awful lot of what is in the Bill.
	I am reminded of an occasion when, in discussion with one of the Minister's predecessors on one of those annual Bills that takes our NHS system to bits and puts it back together again, I wondered aloud whether the day would come when this House would consider a Bill that stated: "There is the Secretary of State and here is a list of regulatory powers". To my horror, I think that that day has come. I am going to put a lot of questions to the Minister because I think it is right to do so. It will save Members of the House valuable time at later stages.
	Anyone who has tried to make sense of the Bill will have found two documents extremely helpful. The first is Making Amends, in which the Chief Medical Officer sets out the need for a scheme and the key elements necessary to make it effective. To the extent that the Bill before us reflects the recommendations made in Making Amends, it has our support. However, as a number of speakers have already pointed out, key recommendations in Making Amends are not included in this legislation. In our view, the principal omission is the duty of candour on health professionals. That is a deficiency and one that we will seek to address during the passage of a Bill which in principle we very much welcome and support.
	The other helpful document is the Full Regulatory Impact Assessment which sets out in detail the background to and rationale for the Bill, and the need for primary legislation. Two very telling statements are made in the assessment, which point out clearly the need for this legislation and its main failings. The first states:
	"New primary powers will enable the delivery of the reforms listed above, and will enable the Scheme Authority to seek financial contributions from participating local bodies and enable these funds to be used to fund the Redress Scheme. Duties could not be imposed on FTs [foundation trusts] and independent providers other than by primary legislation".
	That is a very revealing statement and, were it not for the need to legislate for the inclusion of foundation trusts, I wonder whether the whole matter would have been dealt with by regulation. However, it is a mark of the deficiency of the legislation before us that even informed commentators have had to ask at every stage whether this Bill does indeed include foundation trusts, because they are not mentioned in Clause 1(2) or (3)
	That statement also goes to an issue which so far no one has mentioned. The NHS Redress Bill is just one of a series of measures such as PALs, ICAS and NHS complaints systems designed to enable people to make complaints against the health service. Each of those elements has an intrinsic value, but together they do not add up to a coherent and consistent means by which citizens can hold the NHS fully to account. Now is not the time to rerun arguments about the abolition of the CHCs, but it is fair to say that the range of measures which the Government have put in their place does not offer an effective and efficient system of representation for individuals, nor do we have a robust system of monitoring and addressing failures of healthcare across geographical locations or in respect of distinct patient populations. The noble Baroness, Lady Morgan of Drefelin, said that the measures were "convoluted" and I am concerned that this may be just one more convolution. Moreover, many noble Lords have mentioned one glaring omission; that is, any provision in the Bill for the dissemination of information. Without that it is difficult to see how learning across the NHS can be enhanced.
	The opening statement of the Full Regulatory Impact Assessment talks of primary legislation in the following terms,
	"new coherent powers to enable the scheme to be set out within a single framework of regulations as a real alternative to legislation, and one that will be more readily understood by patients and NHS staff alike".
	That is not what we have at the moment. Specialists in the field do not understand it, so I do not see how lay people can. Yet the statement gives your Lordships a good target at which to aim.
	We have a number of reservations. Some have already been mentioned. The lack of independence of the scheme is a key one, which many of your Lordships have mentioned. The lack of specialist medico-legal advice during the course of an investigation was raised most eloquently by the noble Baroness, Lady Morgan of Drefelin, and by the noble Baroness, Lady Tonge. On these Benches we are concerned not only that patients should be fully enabled to understand the process that they are being taken through, but also that NHS staff can have faith in a system which will explain to people—in much better terms than any existing complaints system—what is happening. The current system has been described by the BMA as harmful, unpredictable and unjust. So it is; but we believe that the Bill, were it to be properly framed, could rectify that.
	One other recommendation by the Chief Medical Officer in Making Amends was that an avoidability test would be preferable. On these Benches, we would like to see that approach probed—not least because it would shift the blame away from individual practitioners and focus, perhaps, more on systemic failures. I listened with great care to the noble Baroness, Lady Finlay of Llandaff, as she made her defence of the Bolam test. Having listened to her, it seemed that there was nothing in what she said that could not have been understood by a patient. It was the sort of full explanation that patients often look for but frequently do not get. If they were getting that quality of information, then a great many cases would not come forward in the first place. An avoidability test, running alongside initiatives such as the National Patient Safety Agency in its Being Open programme, would change practice in ways that would be preferable. We should spend time in Committee looking at that.
	Another reason for drawing attention to the avoidability approach is that the Bill, as it stands, appears to refer only to clinical or medical errors. What is not clear is whether the scheme would include cases in which a wrong diagnosis was made, or a wrong course of treatment pursued for another reason—for example, administrative failure. Clause 1 lists the healthcare staff whose actions are included in the scheme. However, it is not possible to tell, for example, if a lab technician makes a technical mistake or uses equipment which renders a treatment faulty—and that, in turn, causes wrong treatment down the line—whether that will be covered by the scheme. The noble Baroness, Lady Tonge, made that point well.
	There are a number of detailed questions I wish to put to the Minister at this stage. I believe doing so will improve the quality of debate at subsequent stages of the Bill. Clause 1 refers to diagnosis of illness. It does not state that the scheme includes advice given to a patient. Why? Clause 8 concerns the provision of legal advice. What research has been done to ascertain the effect on the Legal Aid Fund? In Clause 8(2) there is reference to a "specified person" who will prepare a list of providers of legal advice. Who will that specified person be?
	Clause 9 deals with assistance for individuals seeking redress under the scheme. It is not clear who should provide the advice, or how they will be paid. Noble Lords will require clarification of that. Clause 9(1) appears to be a provision for the Secretary of State to be given the power to appoint a representative to assist an applicant:
	"by way of representation or otherwise".
	What does that mean?
	Clause 10 refers to the requirement on members of the scheme to make payments. On what basis will contributions be made? Will there be a per capita basis for members of the scheme? Will the fees be risk-related? Will members of the scheme who carry out more complex procedures have to pay weighted contributions? Or will members who have a comparatively poor track record have to pay higher levels of contributions?
	Clause 10 also requires a scheme member to charge a specified person with responsibility for overseeing the scheme. How will that requirement relate to clinical governance and existing complaint arrangements?
	Clause 12 deals with the extremely important matter of disclosure but its drafting is extremely confusing. Does the clause apply to applicants, to scheme members or to both? Access to information is at the heart of any process of investigation or redress and it would be in the best interests of the debate if the Minister could answer this question at an early stage.
	I have one final set of questions for the Minister. How will the scheme be monitored, reviewed and evaluated? How will learning from individual cases be made known and acted upon throughout the NHS? That will be the true test of whether or not the proposals work. It could turn a cost-avoidance measure into a real driver for change and improvement.
	The Minister will be well aware from today's debate that there is good will towards the Bill. This reflects the good will of the population towards the NHS and, as the noble Lord, Lord Parekh, has told us, the desire among people in Britain to remain supportive of our National Health Service and to prevent an American-style litigation culture entering our healthcare system. This kind of legislation involving technical matters comes up once in a very long while, but it provides an important opportunity for the House and Parliament to be at one with the British people in saving our NHS from unnecessary and undue interference from litigation. For all those reasons, I hope the Minister will be expansive in his answers and enable us to speed the passage of the Bill, in an improved form, through the House.

Baroness Morris of Bolton: My Lords, I, too, thank the Minister for his clear explanation of the Bill and I pay tribute to the vast expertise and knowledge that has been shared today in your Lordships' House.
	It may be a small Bill, but it has stirred much interest. My own interest stems from when I was a board member and deputy complaints convener of the Salford Royal Hospitals NHS Trust. I say to the noble Baronesses, Lady Murphy and Lady Tonge, that the drafting of letters and getting the tone right is not easy. After one investigation I wrote a letter which was open, warm and understanding—and was immediately reported to the ombudsman because it was not legalistic. I say to the noble Lord, Lord Turnberg, whom I first met at Hope Hospital, that his voice sounds lovely and that it did not affect his customary good common sense in any way whatever.
	As my noble friend Lord Howe said in his opening speech, the need to reform the system is plain. We are glad that legislative time has been found to consider this issue, albeit two years after the Chief Medical Officer's excellent second report, Making Amends. As my noble friend Lord Colwyn said, we support the idea of greater openness between patients and the medical establishment when things go wrong, but share the concerns so eloquently expressed by the noble Baroness, Lady Neuberger, about how effective that will be.
	We would have liked to have seen greater encouragement of mediation to resolve disputes. The use of mediation has received wide support from a number of bodies, including the NHS Confederation and doctors' groups, and the NHS Litigation Authority has itself adopted a positive policy of encouraging the use of mediation.
	Dr Stephanie Brown of the Medical Protection Society said:
	"The move away from purely financial compensation towards a more comprehensive package of redress for patients including an apology [and] explanation . . . is positive".
	And yet, by focusing, as this Bill does, on monetary compensation, the importance of factual investigation and the knowledge gained from lessons learnt are relegated.
	As many noble Lords have mentioned, and as my own experience has taught me, the majority of people who seek redress from the NHS simply want an answer to the many questions they ask themselves. They want the opportunity to meet the clinicians face to face. In some cases that will be an important part of the grief process, a necessary component if families and individuals are to move on with their lives. Some just want someone to say that they are sorry. There is also a strong sense of the greater good, a need to know that things will change and that wherever possible the same thing will not happen to another person.
	An important litmus test of any scheme that seeks to rectify a wrong is public confidence in that scheme. The Bill will not increase public confidence in the NHS redress system if it enables the NHS to be judge and jury. If the NHS investigates the fault and then awards compensation against itself there is a clear conflict. We on these Benches agree with the noble Baroness, Lady Finlay of Llandaff, that the redress scheme should be robust and limited to an independent fact-finding investigation with the power to make recommendations to avoid the recurrence of similar events. It should not extend to finding blame or paying compensation. The factual explanation received can be used as the basis of a compensation claim which may have a better and fairer outcome for the patient outside the redress scheme. Our proposals reflect patient expectations and priorities.
	We support steps to encourage and support those with a real claim but seek to prevent those looking to attack the NHS unreasonably. As the Medical Protection Society has said,
	"a fair balance needs to be achieved between the rights of patients to receive compensation and the rights of healthcare workers not to be criticised unfairly".
	The Bill takes no measures to protect the NHS against spurious claims and also may encourage patients to settle for £20,000 or less when they should receive more. The Department of Health already acknowledges that that may lead to an increase in costs. Indeed, as the Bill provides for free independent legal advice, how does the Minister know that the cost of legal aid will be reduced? There seems little point in replicating structures and bureaucracies within the NHS when they already exist outside, so the Bill must not replicate the work of the courts; particularly when the Government claim that they are trying to cut down on red tape and improve the effectiveness of public services. Nor must it be allowed to become a free lunch ticket for ambulance chasers.
	The Bill gives the Secretary of State the power to establish, by regulation, a scheme for the victims of medical accidents to obtain redress without recourse to legal proceedings. There have been major concerns that it is a little light on detail. To pick up on an important point made by the noble Baroness, Lady Morgan of Drefelin, if patient X turns down an offer of compensation under the scheme having received free legal advice, will he be denied access to legal aid?
	As my noble friend Lord Howe highlighted, we will be looking during the passage of the Bill to flush out more detail on how the scheme will operate, who will be making particular decisions, the eligibility criteria and awards available. As the noble Baroness, Lady Barker, said, the Bill raises many questions. We will be taking a close look at Clause 11 and like the noble Lord, Lord Parekh, we will want to question the composition of the body that will run the scheme and the nature of any tribunal that will determine liability.
	There appears to be a provision in Clause 9(1) for the Secretary of State to be given the power to appoint a representative to assist an applicant,
	"by way of representation or otherwise".
	We would like to probe the intention of this clause. Any applicant under the scheme, if he or she so wishes, must have the freedom to make their own choice of a person or organisation to assist with any claim. In the absence of freedom of choice, doubts are bound to arise about the impartiality of the adviser.
	The Health Minister, Jane Kennedy, said that her priority is,
	"to encourage openness and a culture that is willing to acknowledge when things have gone wrong".
	The Bill presented the Government with the opportunity to do just that. Yet I share the concerns of my noble friend Lord Howe and others that this opportunity was wasted.
	The British people are not revengeful. Nor do I believe that we yet have a compensation culture. Research shows that following a clinical event that goes wrong, most patients are not after money; as the noble Baroness, Lady Morgan, said, they just want an explanation and, where appropriate, an apology. By concentrating as it does on compensation, our greatest concern is that through the Bill, we may end up with the one thing that we are trying to avoid.

Lord Warner: My Lords, this has been an interesting debate on an important Bill but, I have to acknowledge, there have been varying degrees of enthusiasm for the Government's approach. However, I take some comfort from the level of support for the Bill's underlying principle that those who are damaged by their healthcare deserve a better response than the one they currently receive.
	I was a bit disappointed by the approach of the two Opposition Front Benches; we will no doubt come back to their concerns in Committee. I gently say to the noble Earl, Lord Howe, that I was a bit surprised to hear, by his own acknowledgment, that the Conservative Front Bench wanted to create a lengthier, more bureaucratic scheme involving a second body, the Healthcare Commission, possibly, which already has onerous duties. I was particularly surprised, given the noises that have come from the Conservative Front Bench in the other place about excessive bureaucracy and the need to cut red tape. I ask the noble Earl to reflect on the fact that when we get to Committee, we shall look very carefully at whether proposals from Opposition parties would make the scheme lengthier, more bureaucratic, less easy to work and would create a more complicated set of arrangements for patients to work their way through. I hope that we will be able to keep those considerations in our mind as we discuss the details of the scheme in Committee.
	A number of noble Lords referred to the report Making Amends and have implied that we have cavalierly dropped most of the Chief Medical Officer's recommendations. The NHS redress scheme is designed to take forward one recommendation, but we are working with other government departments to take forward other reforms proposed in Making Amends. For example, we are taking forward recommendations 6 and 8 on reforms to the NHS complaints procedure and we are considering taking forward recommendation 17, which will prevent court awards reflecting the cost of private treatment as part of wider reform to Section 2(4) of the Law Reform (Personal Injuries) Act 1948 in conjunction with the Department for Constitutional Affairs. I am very happy to write to noble Lords before Committee to set out how some of the proposals are being taken forward in a different way outside the Bill, so that there is no misunderstanding when the Bill reaches Committee.
	A number of noble Lords have referred to why the scheme for severely neurologically impaired babies is not in the Bill. Since Making Amends was published, the National Service Framework for Children, Young People and Maternity Services has been published. This is a 10-year plan and includes a developmental national standard to address the requirements of all young people who are disabled. On 12 October 2005, we published a statement of intent which sets out action planned and already under way to meet the complex needs of this group of children.
	I remind noble Lords that, because of the high value of financial redress attached to such cases, severely neurologically impaired babies are likely to be outside the scope of the NHS redress scheme. However, I can give further and better particulars on this issue to noble Lords in writing before Committee.
	Several noble Lords asked why the scheme does not currently cover primary care settings. Most incidents of clinical negligence in primary care settings would result in very small-value claims the handling of which would incur high administrative costs. GPs and other primary care practitioner organisations have private indemnity arrangements with the Medical Defence Union and the Medical Protection Society. As the noble Lord, Lord Turnberg, said, these are private organisations which collect insurance-type premiums from their members. Further discussions need to be held with the stakeholders to establish how funding flows would work if the NHS Litigation Authority as the scheme authority were to take over a significant proportion of their low-value claims via the NHS redress scheme. Inevitably, that would need amendments to legislation, but it is a complicated issue.
	The issue of rights of appeal was raised by a number of noble Lords. At present, the Bill does not propose the right of appeal, but if a patient is dissatisfied with an offer made under the scheme, the patient may reject the offer and seek redress through the courts. Patients will get access to the independent legal advice on the offer that is made to them without charge.
	I was asked whether there would be an independent element. The aim of the NHS redress scheme is to support local resolution. However, where patients are unhappy, a complaints procedure will be in place.
	Several noble Lords asked about time limits. The detail of the scheme will be set out in secondary legislation. I assure noble Lords that it is intended that full consultation will take place to ensure that the fine detail of the scheme—such as the exact time limits that will be set at each stage—is worked out in a way that enables the scheme to operate effectively in practice.
	I could not resist smiling—the noble Baroness, Lady Tonge, caught me—when she was delighting the House with stories of exhausted health professionals bowed down by government targets. I remind her gently that those targets arose because patients actually made the not unreasonable request that we improved access to GPs, improved accident and emergency services and had shorter waiting lists. I am sorry if she and her colleagues are bowed down, but I read recently in the media that our GPs were actually paid rather well compared with the rest of Europe so there seems to be some compensation for the onerous responsibilities that they discharge. As I remember, GPs were relieved of their obligations on out-of-hours services under the changes that we introduced as a result of discussion with them. I thought that we should put the record straight in that particular area.
	Noble Lords raised the important issue of whether we could be heading towards a US-style litigation culture. The noble Baroness, Lady Murphy, touched on that. In terms of clinical negligence claims specifically, claims against the NHS actually continue to fall. An average of 439 claims per month were made under the clinical negligence scheme for trusts in 2004–05 compared with 481 in 2003–04. That is still more than we would like, but the trend is not going upwards: it is going in the opposite direction.
	Several noble Lords, and the noble Baroness, Lady Finlay, in particular, raised the issue of the Bolam test. Any offer of redress will be made only on the basis of a liability in tort arising under the law of England and Wales. The same test for negligence as applied in civil proceedings will be applied to cases under the redress scheme. Those tests are currently the Bolam and Bolitho tests. The Bolam test provides that a professional is not negligent if their practice was in accordance with that accepted as proper at the time of treatment by a responsible body of medical opinion, even though other doctors adopt a different practice. I will not go into the detail of that, but I am trying to reassure her that we are not changing the test in any way under this legislation.
	The noble Lord raised the issue of the NHS Litigation Authority having a conflict of interest. I am anxious not to end up with such a complicated set of arrangements that they are off-putting to patients. It is intended that any patient who is offered a settlement under the scheme will be given the opportunity to have the offer assessed by independent legal advice, which will be provided without charge. It is not just the NHS Litigation Authority calling all the shots, although it has considerable expertise. We can go into the detail of determining liability at the appropriate level in Committee. The measure has a lot to offer, and I hope, in Committee, to convince your Lordships of that.
	Noble Lords have rightly chided us and asked when they will know the detail of the scheme. Regulations will not be published until after Royal Assent, but there will be full consultation on draft regulations before the scheme starts, which we envisage to be April 2007. The issue of whether it will take the NHS in the wrong direction regarding how it deals with patients' concerns has been raised. We know, and I shall give further and better particulars in Committee, that many of the best trusts are already looking at how best to respond to patients when things go wrong. We want to support all NHS organisations to reach that standard, and we think that the Bill will help to do that.
	The issue of whether the NHS redress scheme will cover MRSA was raised. The scheme will cover claims arising out of hospital services provided to patients as part of the National Health Service in England. It may cover cases involving MRSA if there is liability in tort and the case falls below the financial threshold. I like dealing with health Bills in this House as we invariably get on to the issue of cross-border flows between England and Wales. No doubt we shall discuss that subject in Committee when I shall no doubt receive support from the noble Baroness, Lady Royall. I can tell the noble Baroness, Lady Finlay, that the Department of Health and the Assembly have been working together on the proposals. Wales has broad regulation-making powers that do not commit it to establishing a scheme. However, clear guidance will be developed for all cross-border services, and commissioning responsibilities will be agreed at the outset. There will be no uncertainty for patients or providers.
	I was asked whether doctors would be blamed, but the scheme is intended to resolve claims outside the adversarial process. We do not think it is likely that the scheme will increase the possibility of doctors being blamed. Claims under £20,000 currently cover about 75 per cent of settled claims. My noble friend Lord Parekh asked about the number of claims involved in the past few years. The average number of settled claims under £20,000 in financial years 2001–02 to 2003–04 was around 4,000 a year. That represents approximately 75 per cent of settled claims. I was asked whether the cost limit included remedial treatment costs. It does not. Remedial care based on clinical need will be provided under the NHS as a matter of course in particular cases.
	The noble Baroness, Lady Barker, asked who would hold the list of solicitors. It is intended that the list will be made available by the Legal Services Commission. She also asked whether misdiagnosis would be covered. Any case when there is a liability in tort, based on the current legal test, will be eligible, provided that liability arises out of services provided in hospital and in consequence of the act or omission of a healthcare professional. That would be the test applied if there were concerns about misdiagnosis.
	I was asked how the scheme would be funded. We expect it to be funded along the same lines as the clinical negligence scheme for trusts. The detail of the funding mechanisms will be set out in secondary legislation and the contribution paid by each scheme member will be advised by the NHS Litigation Authority. Contributions may be adjusted in the light of the relevant risk rating of each individual scheme member.
	I have tried to cover as best as I can some of the issues raised. I assure noble Lords that I shall study Hansard carefully and will reply to all the questions to which I have not given full and frank answers in this debate. As it is in my best interests, I shall endeavour that the letters get to noble Lords before Committee, so I can guarantee to write to noble Lords on those particular issues.
	On Question, Bill read a second time, and committed to a Grand Committee.

Millennium Review Summit (EUC Report)

Lord Bowness: rose to move, That this House takes note of the report of the European Union Committee on the European Union's role at the millennium review summit.

Lord Bowness: My Lords, this relatively short report was produced during the summer in anticipation of the millennium review summit, which was held in September. Before turning to the substance of the report itself, I record my thanks to the members of Sub-Committee C of the European Union Committee for their work in the preparation of the report; to Benita Ferrero Waldner, the Commissioner for External Affairs; to Mr Daws, the executive director of the United Nations Association in the United Kingdom; to Sir Jeremy Greenstock, the former representative of the United Kingdom to the United Nations; and to Mr Douglas Alexander, the Minister for Europe, for giving evidence to the committee. I also record our particular thanks to the noble Lord, Lord Hannay of Chiswick, who, before joining the sub-committee as a member and assisting us with his knowledge and expertise of the subject also, as long ago as May 2004, gave evidence to the committee on the work of the Secretary-General's high-level panel of which he was a distinguished member.
	There was pressure to produce the report by the summer, and I am grateful to Emily Baldock, the committee clerk, and Pamela Strigo, the committee specialist, in the drafting of the report and enabling us to meet our self-imposed deadline.
	The report has inevitably been overtaken by the events to which it looked forward, and I know that the noble Lord, Lord Hannay, will deal with the outcome of the millennium review summit, so I do not propose to dwell too long on that myself. But it is worth looking at the report and the Government's response. In September 2005, the heads of the United Nations member states met in New York to mark the United Nations 60th anniversary. They were there to review the progress of the millennium development goals on the basis of the report commissioned from the Secretary-General, entitled In Larger Freedom, but that report went much further. It was divided into four sections, which our report tends to follow. A much larger point was, as our report states, the question of the United Nations' role in the post-Cold War world.
	We, as a sub-committee of the European Union Committee, were anxious to see what the European Union's role would be in that. The Secretary-General's report, In Larger Freedom, consisted of four main themes: Freedom from Want—the Development Agenda; Freedom from Fear—the Security Agenda; Freedom to Live in Dignity—Human Rights and Democracy; and Strengthening the United Nations—Reform of the Institutions. The sub-committee recognised at the start that the United Nations is an organisation of sovereign states. The European Union has only observer status, but we also observed, and witnesses confirmed, that among the many groups there, the European Union stands out as the most cohesive and the one that is most likely to assist in collective action. One of our recommendations, which one might have thought was a statement of the obvious, was that to ensure and endeavour to achieve a successful outcome at the summit, the European Union must advocate the case for reform, use its particular relationship with the United States and have a dialogue with countries in the other continents.
	The Secretary-General, in the "Freedom from Want" section of his report, urged all the UN member states to implement the global partnership between rich and poor countries. It is worth noting that the committee commended the European Union for its pre-stated commitment to increased aid. The EU is still the largest contributor to overseas development aid.
	We also commended the Government for having made a brave and principled decision to pick climate change as one of their key priorities for the United Kingdom's European Union and G8 presidencies. We urged the Government to seek agreement at the conference to begin in November and proposed that a specific date for the post-2012 discussions be included in the millennium review summit draft outcome document. We would like to hear from the Government whether those discussions commenced on time.
	Regarding "Freedom from Fear—the Security Agenda", we urged the European Union to,
	"press for new principles on the application of force",
	and we endorsed the concept of the responsibility to protect. We are pleased that that was recognised. We also suggested that the Government should press for as much detail as possible in the conclusions regarding the setting up of a peacebuilding commission. Although the Government agreed with that in their response, one of the key issues as we see it is that it is not clear how that will relate to and work with the Security Council. It would be extremely helpful if the Minister could respond to that. We were also concerned that a definition of terrorism should be achieved at the summit. That has not happened and, with great respect to the Government, their response is set out in rather complacent terms, bearing in mind that that was a particularly important issue.
	Regarding the section, "Freedom to Live in Dignity", the sub-committee supported the proposal for a new human rights council which we hoped would be more effective than the existing institution. We hoped that the Government and the European Union would support the measures proposed at the summit that would strengthen the UN's human rights machinery. As we understand it, that new institution was established but, again, can the Minister give us more detail and information on the progress that has been achieved?
	On the reform agenda, strengthening the United Nations institutions, we always knew that reform of the Security Council was not a matter on which the member states of the European Union would be able to agree. Indeed, that proved to be the case. We also called for the Government to indicate how they believed the United Nations General Assembly could, in the words of the report, be revitalised and work towards the Secretary-General's reforms. The government response indicates that a working group was set up, but it does not indicate what proposals and measures the Government would advocate and be pressing in conjunction with our partners in Europe.
	Lastly, I draw noble Lords' attention to the fact that, while the summit achieved only partial success, the European Union itself was successful in producing a co-ordinated position at the summit. As I have already said, with the exception of the Security Council, that co-ordinated position seems to have been maintained throughout the process. By focusing on the areas of agreement, the European Union was able to contribute positively to the positive elements of the outcome of the summit—a lesson which we should perhaps consider when we sometimes discuss the desirability, or not, of having a common foreign and security policy. Failure to be able to agree on absolutely everything is no reason not to try to achieve agreement on as much as possible. The result of the summit in that regard at least suggests that those efforts were not only for Europe's collective benefit but also for the benefit of the United Nations. I beg to move.
	Moved, That this House takes note of the report of the European Union Committee on the European Union's Role at the millennium review summit.—(Lord Bowness.)

Lord Truscott: My Lords, I begin by commending the noble Lord, Lord Bowness, for the excellent way in which he guided EU Sub-Committee C through the various stages of the report. As the noble Lord mentioned, we also benefited from the expertise and special knowledge of the noble Lord, Lord Hannay, who appeared as both a witness and a committee member and greatly assisted in the drafting of the subsequent report. I look forward to hearing his speech later in the debate.
	The importance of the EU/UN relationship is self-apparent. EU member states are the largest financial contributors to the UN system, as the noble Lord, Lord Bowness, mentioned. The EU pays 38 per cent of the UN's regular budget, more than two-fifths of the UN peacekeeping operations and around half of the UN member states' contributions to UN funds and programmes. Thus, in my view, the committee's report is both timely and an important contribution to the debate about the role and influence of the EU within the structures of the United Nations.
	Overall, as the Minister, my noble friend Lord Triesman, told your Lordships' House on 10 October, the resulting millennium review summit,
	"delivered a worthwhile package of reforms and commitments".—[Official Report, 10/10/05; col. WS 10.]
	My own feeling is that, although there were disappointments at the September UN world summit, there were also significant advances. The noble Lord, Lord Bowness, mentioned that one of those advances was the way in which the EU member states themselves maintained a co-ordinated approach to the negotiations at the summit. I would argue that the outcome was not as disappointing as some commentators would have your Lordships believe, and I hope that the Minister, in responding to the debate, will concur.
	There was a strong and unambiguous commitment by all governments, of donor and developing nations alike, to achieve the millennium development goals by 2015. An additional $50 billion a year would be found by 2010 to fight poverty. There was agreement to provide immediate support for quick impact initiatives to support anti-malaria efforts, education and healthcare.
	For the first time, the UN agreed a clear and unqualified condemnation of terrorism by all governments,
	"in all its forms and manifestations, committed by whomever, wherever and for whatever purposes".
	There was a strong push for a comprehensive convention against terrorism within a year and support for early entry into force of the nuclear terrorism convention. The Government managed to secure the adoption of the Security Council resolution calling on all countries to ban the incitement of terrorist acts, despite the failure to agree on a definition of terrorism, as the noble Lord, Lord Bowness, mentioned.
	UN members could not agree on a definition of terrorism that treated attacks targeting civilians and non-combatants by non-state agents as terrorist acts. The logic is that similar acts by governments are already proscribed as war crimes. Some countries insisted that the definition of terrorism should exclude "legitimate" struggles for liberation and self-determination.
	Although it is often said that one person's terrorist is another person's freedom fighter, it is disingenuous to suggest that blowing innocent children, women—and men, for that matter—to pieces in any political cause is other than terrorism. Was the killing of more than 150 children in Beslan in North Ossetia in September 2004 not terrorism because some of the terrorists felt that they were fighting for self-determination? I think not. Of course the world must avoid double standards, but, on the other hand, the civilised international community is entitled to say that there are lines that rational human beings should not cross, whatever the cause, whatever the war.
	The UN world summit also agreed to build a peacebuilding commission backed by a support office and a standing fund. There will also be a standing police capacity for UN peacekeeping operations. Human rights machinery is to be strengthened; a human rights council established within a year; the Convention against Corruption came into force; and a new ethics office, badly needed following the Volcker reports, will help strengthen internal oversight. There was recognition of the serious challenge posed by climate change and a commitment better to tackle HIV/AIDS, TB and malaria. An improved Central Emergency Revolving Fund would ensure that relief arrived more swiftly and reliably when disasters happened. The signatories reconfirmed the Monterrey consensus, in which they pledged to,
	"make concrete efforts towards the target of 0.7 per cent of GDP in official development assistance".
	Of course, the key is to turn those fine words into action. That process should be helped by a little-noted clause, paragraph 22a, in the outcome document, in which all UN members agree to,
	"adopt, by 2006, and implement comprehensive national development strategies to achieve the internationally agreed development goals and objectives, including the Millennium Development Goals".
	From now on, development strategies prepared by bodies such as the International Monetary Fund and the World Bank should be comprehensive and designed to achieve the development goals. That is a new concept which, it is hoped, will force a change in the behaviour of institutions and governments around the globe.
	Another major breakthrough was the clear and unambiguous acceptance by all governments of the collective international responsibility to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity. When peaceful action proves inadequate and national governments refuse to act, the Security Council will have the responsibility to protect the innocent. The responsibility to protect, which was initially resisted by Egypt, Algeria, Pakistan, India, Russia, Cuba, Iran and Syria, was finally pushed through in New York. The UN world summit is to be congratulated for overcoming resistance among some of its participants to the principle that people sometimes need to be protected from their own governments.
	Of course, the world summit was not a resounding success in all areas, as I mentioned in the case of the definition of terrorism. Secretary-General Kofi Annan rightly said that it was a "disgrace" that no progress had been made on disarmament at the summit. The committee's report before your Lordships' House stated that the earlier NPT Review Conference was a "disastrous failure" and that non-proliferation should have been one of the Government's priorities in New York. The Government's response to the committee's report acknowledges disappointment in that area and promises to,
	"find pragmatic solutions to overcome that setback and enhance the non-proliferation regime".
	In the dangerous world in which we now live, solutions cannot come soon enough. I hope that the Minister will reflect on the response required by the Government in this area.
	Post-2012 climate change commitments will be discussed at the December 2005 climate change conference, but the UN review summit itself took no decision on further international action. On both the peacebuilding commission and the human rights council, issues still remain outstanding. Progress on the issue of Security Council reform, on which the noble Lord, Lord Hannay of Chiswick, expended so much effort as a member of the high level panel, was non-existent.
	The only positive thing which could be said about Security Council reform was that the subject did not derail the whole millennium review summit, as some feared it might. Reform of the General Assembly also seems some way off. Consensus among a body with 191 member states is understandably sometimes beyond the reach of even the best diplomats.
	The UN millennium review summit achieved a lot but, as someone once said, there still remains a lot to be done.

Baroness Falkner of Margravine: My Lords, before I commence, I should declare an interest in the context of this report for those Members who have not seen the report itself, in saying that the House may wish to know that my sister is UN Deputy High Commissioner for Human Rights. Having said that, I have not consulted her at all in forming my opinions on the report.
	I came to the committee in the final stages of its deliberations on the report. The analysis within it is extremely pertinent to the many issues that the UK will have to grapple with in the remaining time of its presidency of the EU. In those late hours as the report was being finalised, I should extend my thanks to our chairman, the noble Lord, Lord Bowness, whose wise guidance on what we should really focus on was invaluable to a new member like myself.
	UN summits are not always as relevant as they might be. However, given contemporary geopolitics and the state of multilateralism, both in the wider framework and within the EU itself, this summit was always going to be a testing one. In aspiring to do as much as it sought, the UN was perhaps being over-ambitious. Perhaps it should have concentrated on the critical areas of how we might actually achieve the millennium development goals—no small matter when it comes to halving extreme poverty, providing an education for all the world's children or combating the reduction of infectious diseases—rather than attempting to embrace the broader, but also deeply important, agenda of UN reform.
	In the committee, we too had a wide-ranging agenda in reviewing EU relations with the UN. I will confine my remarks to three areas only: the convention on terrorism, the human rights council and the reform of the UN organisational structure. In doing so, I wish I was speaking after the noble Lord, Lord Hannay of Chiswick, as his knowledge of matters relating to both the UN and the EU is far superior to almost anyone else in this House and therefore much of what I say may well be made redundant when he speaks.
	In representing the EU at the UN, and bearing in mind how much more important the EU is to the UN now, given that we contribute, as many noble Lords have said, almost 40 per cent of the regular budget, the UK Government had particular leverage at this summit. That it was able to achieve as much as it did in the context of the MDGs, and particularly in achieving agreement on responsibility to protect, is to be welcomed. However, given that the EU went into this summit in a more united position than the recent past—one only has to think back to 2002 and 2003, when EU divisions would have been rather more evident—it is to be regretted that more could not be achieved.
	A significant failure was the inability of the UN to arrive at a successful outcome on the convention on terrorism. Had that been achieved, it would have been of more than symbolic importance, as it would have resulted in genuine commitment on the parts of other states to meet their responsibilities in this regard. The reason we were unable to get agreement was that the Organisation of the Islamic Council, which represents 57 Muslim countries, was reluctant to agree terms whereby legitimate struggle for autonomy and/or self-determination could be made unlawful. As many of those struggles relate to Muslim populations—not least those in Palestine and Kashmir, not forgetting the plight of Chinese Muslims or those in Russia—it was not entirely surprising that we could not succeed. So we will probably not gain agreement on this most contentious issue of our time, and that is to be regretted.
	We should note in the context of terrorism that the UN Security Council did indeed agree Resolution 1624, which is wide-ranging. I mention it because the Government have invested so much political capital in this resolution, recalling time and again that it is now under obligation to abide by that resolution in the context of the Terrorism Bill which is currently being debated in the other place. But there is a warning here: we must be very careful not to adopt a pick-and-choose approach to international law or we will bring it into disrepute. So while our Government remind noble Lords on the opposition Benches of their commitments to multilateralism, they might pause to reflect on their own standards of adherence to measures for international peace and security in contemporary times. They should also note those sections of the resolution that call on states to take measures as may be "necessary and appropriate". The resolution also stresses that states must ensure that measures comply with international human rights law. I could go into detail about why I think that Resolution 1624 does not comprehensively support the Government's case, but this is not the debate for that.
	A further disappointment was the lack of progress on agreement for a human rights council. That was all the more disappointing as, I believe, the concern of certain developing countries that the new council would sideline them and work only to the Western agenda was predictable—and what is predictable is, to some extent, resolvable. The failure to move forward in that regard can be explained partly by the lack of dialogue between those who could see themselves losing voice through the reforms and those who would gain. With greater forward planning we might have had progress.
	The debate will now centre on how wide the membership of the council should be. I have some experience in that regard: in addition to the interest that I have already declared, I worked for the Commonwealth secretariat for several years and was responsible for the ministerial committee for human rights and democracy. On the whole, the Commonwealth committee—the Commonwealth Ministerial Action Group—has been quite successful. In response to violations of fundamental principles in relation to Zimbabwe and Pakistan, it was able to bring some sanctions to bear. If the human rights council is to have any influence in advancing human rights, the one lesson that we should draw from the Commonwealth is to keep the council a reasonable size to achieve coherence for oversight. Current thinking is that the council may have as many as 47 to 50 members. That should be avoided. Creating a body with a quarter of the membership of the UN will not be the recipe for achieving either consensus or common positions. An effective council must have a manageable membership, and the EU should bear that in mind, even if it has to compromise its own interests in terms of membership and numbers. In doing so it will advance the cause of human rights overall, and that must be a good thing.
	Finally, I come to the overhaul of the UN system itself. The UN Secretary-General commented two years ago that the UN was at a fork in the road: on one side lay reform and renewal and on the other lay growing irrelevance. Those sentiments expressed a growing sense of frustration among capitals that the UN could no longer just muddle along; however, that seems to be where we find ourselves and where the EU, as a significant contributor across the board, has much leverage. That it failed to achieve the required reforms will have direct implications for the UN's present accountability and future mandates. At present, the mismanagement of the Oil for Food Programme is a case in point. As the Volker report made clear, the split responsibilities between the secretariat, the Security Council and the General Assembly render the lines of accountability much more diffuse. An overhaul of the UN staffing regime is also needed, if only to clear out dead wood with a move to greater flexibility to achieve staff turnover, which would greatly benefit efficiency. A streamlined secretariat, with clearly defined and greater powers for the Secretary-General, is needed.
	Overall, the summit was a missed opportunity for both the UN and the EU. That we failed to achieve the radical but necessary reforms means that we will have to muddle through a bit longer. However, a debate is now under way, and we must be determined to continue pushing the reform agenda even as we hand over the EU presidency. Our responsibility as a permanent member has historically been discharged with great commitment. We look forward to renewal of that commitment towards both the UN and the EU.

Lord Hannay of Chiswick: My Lords, it could be thought that for this House to be debating a report on the European Union's role in the UN millennium review summit, which took place a little over a month ago in New York, might be missing the bus, but I do not believe that is so. This report ranges a good deal more widely than the agenda of the summit meeting itself. It looks into what the United Nations means for the EU's emerging common foreign and security policy, and looks also at what the EU's member states, acting jointly through that policy, can and should be doing at and for the UN.
	The report also constitutes a kind of baseline from which to judge the outcome of the summit. As a newcomer to his sub-committee I would like to convey a word of appreciation to the noble Lord, Lord Bowness, who chaired our deliberations so ably, and to our excellent staff who helped to put together our report under considerable pressure of time, not to mention the "noises off" such as the atrocities on the Underground on 7 July, which coincided precisely with one of our meetings, and certainly concentrated our minds on one of the main threats facing this country and the UN as a whole: terrorism.
	I have seen it suggested that the EU's input into the preparation of the millennium review summit was a bit feeble and inadequate; that its collective voice was not properly heard. That is nonsense. Not only was a dialogue struck up from the outset with the two members of the high-level panel from EU countries, myself and M Robert Badinter—to whose perspicacity and contribution I pay tribute—but a detailed written submission by the EU was entered in July 2004. In June this year the heads of state and government of the EU adopted a position highly supportive of the UN Secretary-General's reform proposals, and, in the long and tortuous—not to say tortured—negotiations over the outcome document, the EU, under the leadership of the British permanent representative, played a prominent and unfailingly constructive role without which, it can safely be said, there would have been no agreed outcome at all. I know of no other country or group of countries that made a greater input into the preparation of the summit, nor of any whose policy prescriptions were such a close fit with the proposals put forward by the panel and the Secretary-General.
	As previous speakers have mentioned, on the proposal regarding enlargement of the Security Council and the question of whether that should include new permanent members, the EU was divided from the outset and remained so to the end. On the rest it was united, as it was on the overall proposition that reforming and strengthening the UN was a major objective of its policy. Not too bad a score, I would suggest.
	Why does the UN matter so much to the EU? The answer is simple, and it is set out in our report. The EU has major global interests to defend and to further, but it does not suffer from the illusion that it can do that unaided, powerful and prosperous though it may be thought to be by some; nor does it seek to become some sort of superpower, let alone a "superstate", aspiring to get its way outside the constraints of international law and practice. So it has nailed its colours to the concept of effective multilateralism, one of the leitmotifs of its own security strategy. For effective multilateralism to work, you need an effective UN that can deliver on the tasks it is set collectively by the international community.
	Why, in its turn, does the EU matter so much to the UN? The answer is a matter of simple arithmetic. Some 40–50 per cent of the resources of all UN programmes come from the enlarged European Union. It goes wider than that, however. For the UN to work effectively it needs the firm support of a critical mass of countries that have worldwide outreach and the resources and political will to back up the UN when the going gets rough. The EU has at least the potential to provide that, even if hitherto it has often fallen a bit short of doing so.
	What is one to say about the September summit? I myself would say two cheers at best; certainly not three. Quite a lot of highly desirable proposals got lost on the way. Enlargement of the Security Council remains stuck, as it has been for over 10 years. It will return, like Banquo's ghost, to haunt the UN's deliberations. The proposal to set guidelines for the collective use of force fell foul of an unholy alliance of those who thought that they were too constrictive and those who thought that they were too permissive. The decisions on counter-proliferation policy were simply dropped in their entirety, an ominous omission that bodes ill for the future, following as it does the debacle of last May's Nuclear Non-Proliferation Treaty Review Conference. The truncation of the responsibilities of the new Peacebuilding Commission to exclude conflict prevention will surely come to be regretted.
	Nevertheless, set against those failures is a certain number of successes: the establishment of the Peacebuilding Commission; the endorsement of a strategy against terrorism and the commitment to a comprehensive convention that, in my view and that of other speakers, needs to outlaw any targeting of civilians or non-combatants; the commitment to the responsibility to protect those whose governments cannot or will not do so themselves; the decision to set up a new council on human rights; and the measures to make the work of the General Assembly, the Economic and Social Council and the secretariat more relevant, better focused and more accountable. There is also the recalibration of the millennium development goals with additional resources and a new sense of purpose. I would argue that the decisions that were taken represent a critical mass of reforms of real value, a reform programme that could be seen as being wider in scope than any adopted since the UN was set up in 1945.
	Will it all happen? Will it work? That, naturally, will depend on the follow-up and the implementation. If the Doha development round bogs down; if the new dialogue on global warming runs into the sands; if the convention on terrorism is shipwrecked on the quicksands of disagreement over definitions; if the first case of need to exercise the responsibility to protect is fluffed, flunked or fudged, as has happened so often; if the resources for the development policies and the policies themselves fall short of the promises of Gleneagles and New York; or if the Peacebuilding Commission becomes a fifth wheel rather than a motor for post-conflict peace building, it will be yet another false dawn, yet another opportunity missed.
	That brings us back to the European Union's role. It cannot on its own be determinant in the positive sense on any of the issues. Wider co-operation is needed than simply among members of the European Union. There must be co-operation with developing countries and, above all, the emerging giants among them, such as China, India, Brazil, Nigeria and South Africa. There must be co-operation with the United States, whose somewhat enigmatic and ambivalent approach to UN reform and the summit still leaves plenty of unanswered questions. There must also be co-operation with the long-term, stalwart supporters of the UN, such as Canada and Japan, whose approach often matches closely that of the European Union.
	The European Union's role can be and often is determinant in the negative sense. If it does not provide resources in men, money and political backing, the UN will get nowhere. I hope that we shall hear from the Minister how the Government, during the rest of their EU and G8 presidencies, will set those organisations off along the long and arduous path of effective implementation of the reforms endorsed. Also, how do the Government intend to proceed in the areas in which nothing has been achieved, most pressingly on counter-proliferation policy?
	The European Union has a particular stake in the whole process that relates to its internal development as well as to the wider world. There is no doubt that the European Union, like the UN, is going through choppy seas. Like the UN, it needs reform. In the case of the European Union, the institutional path to reform is not only inadequate on its own but is probably blocked for some considerable time, following the negative outcomes of the French and Dutch referendums. I believe that, in the immediate future, the EU's salvation lies through making its policies more effective, more credible and more apt to the needs of its citizens. That is the best way—perhaps the only way—to rebuild the support that has ebbed away but is there to be regained.
	One of the EU policies that needs to be developed, strengthened and made more visible and comprehensible to the general public is the common foreign and security policy. Is it to remain a mass of apparently meaningless acronyms, a system for writing cheques while others shape the decisions, or is it gradually to become a means of delivering outcomes that our citizens genuinely want and value, such as greater security against terrorism and the proliferation of weapons of mass destruction; greater respect for human rights world-wide; and greater prosperity and freedom from disease, hunger and want for those less fortunately placed than ourselves? It is to answering those questions that the European Union must now address itself with renewed determination and purpose.

Lord Lea of Crondall: My Lords, first, I echo what has been said by a number of speakers. As my noble friend Lord Truscott said, we are grateful to our chairman for his leadership during the writing of the report by the committee of which I am a member. We are grateful in particular to the noble Lord, Lord Hannay, who has demonstrated during the past few minutes exactly why his unique overview and ability to see the whole problem of the UN in the round from his experience as an ambassador and on the high level panel was a uniquely valuable contribution to our work. I hope that I do not plagiarise his speech, but my balance sheet will sound somewhat similar.
	I echo my noble friend Lord Truscott. I was not aware of the remarkable statistic—it is reproduced on page 12 of the report—that the EU countries together provide 38 per cent of the UN budget. The United States provide 22 per cent. The United States are the sole superpower. There is not time to compare the United Nations with the League of Nations. However, perhaps we should reflect on one or two points of impasse regarding non-proliferation and the Security Council—there are some pluses on climate change—reflecting on the constitution in a broader sense.
	There has always been a problem with organisations where everyone has a right to be a member. The African Union is different, therefore, from the European Union. We shall study the relationship between the African Union and the European Union and scrutinise it in a wider sense over the next few months leading to a proposed EU/AU summit. Different organisations have different internal dynamics. To get them to move forward and to take on more authority is a constitutional question. It is obvious that the United Nations is only as strong as some of the contributions made by key members of the Security Council—the United States, primus inter pares, and it must be true of China and Russia. It is somewhat disturbing that the new US ambassador to the United Nations is not looking for a stronger role for the UN. Yet when we consider specific policies, as my noble friend Lord Hannay, said, all the forces of history demand that.
	Perhaps I may make a slightly jocular aside. For 35 years I helped to run the TUC, in various lowly and less lowly capacities. When we got into difficulties, going round in circles and going nowhere in particular, we always used to say, "The problem is that running the TUC is rather like running the United Nations. You can't really do anything as you have very big members throwing their weight about". To coin a phrase, the problem with running the United Nations is a little like running the TUC. That may not have the same resonance with other people as it has with me, but it is worth reflecting on what is needed to make an organisation cohere.
	Compared with the UN, the EU has some remarkable success stories. The noble Lord, Lord Hannay, touched on one or two of them. Even drawing up and agreeing between the 25 member states a substantive report on the non-proliferation treaty that formed the hymn sheet to be used in New York was quite an achievement. The common foreign and security policy is a fancy title because it has to be based on unanimity, but historians will look back and note that the EU is doing more and more at an impressive speed. I am sure that that is the kind of setting against which we ought to judge some of the less than brilliantly successful outcomes we have seen recently.
	We have seen the UN move a considerable distance on climate change over the past 13 to 14 years. In 1992 I happened to be an expert adviser as part of the UK delegation to the Earth Summit held in Rio. At the time the possibility that the Kyoto Protocol would be agreed in any form, and that the newly developing industrial nations such as India, China and Brazil would relate to the system, was very remote. The debating point of the day was that it was the duty of the great industrialised powers of the developed world, those which created pollution with their carbon dioxide emissions, to give the lead; we could not expect the participation of India and China. Today we are finding the modalities where that is starting to happen. In historical terms, that is happening over a short period.
	The noble Baroness, Lady Falkner of Margravine, said that there is a crisis of multilateralism. I tend to agree, but it is worth stating its nature .

Baroness Falkner of Margravine: My Lords, just on a point of clarification, I do not believe I said that there is a crisis of multilateralism, rather that we have obligations as multilateralists.

Lord Lea of Crondall: My Lords, I apologise if I wrongly paraphrased the noble Baroness. But I think that there is a crisis of multilateralism, and I shall put it in my own terms. There should be a form of high-level brainstorming on the nature of the negotiation which is now meant to be developing on issues such as the non-proliferation treaty. The traditional way in which documents are drawn up for meetings such as the NPT review conference, which was such a comprehensive failure, shows that lessons ought to be learnt. During their presidency, which has only another six weeks to run, could Her Majesty's Government put into play the notion that there ought to be a reflection on what the failure of the NPT review conference can tell us about the nature of multilateral modalities? I ask that because we have another fast-emerging problem; that is, the Iranian question.
	We have suggested both in the report on the non-proliferation treaty and more generally that it would be desirable to experiment, through Britain, France and Germany, with reporting to the Council of Ministers, and then Europe taking a lead in the UN system. There has been some rather facile talk recently of going to the Security Council. To do what, exactly? Either building on the alliance of the UK, France and Germany or the failure of the NPT treaty conference, it would be very useful indeed for the Government to give a lead to the setting up of a high-level forum or brains trust—it does not matter what it is called—to think through some of the problems attached to the modalities of multilateral negotiation.
	On millennium development goals more generally, I do not agree with the noble Baroness on this occasion. I definitely do not agree that we should have given more prominence in New York to the progress on MDGs. I see totally the reverse. MDGs are, in a sense, dependent on an average 7 per cent economic growth across the developing world. That is a tremendously ambitious target, but what is the problem with achieving it? It is largely, in our analysis, the problems of corruption, of governance and money-laundering—which comes back to London and Jersey and such places. It is also the problem of trade, with the Doha round, and the problem that in Africa we have a doctrine of non-interference in the internal affairs of sovereign states. That is the problem with the MDGs and getting to that 7 per cent. It is not just waving magic wands about economic arithmetic. We now have an ambitious agenda because we cannot avoid some of these challenging questions.
	The Front Bench may be glad to know that I want to conclude by asking for this note to be attached to the Government's reply. I do not think anyone else has mentioned the interesting note in the annexe on conditionality. There is a not unintelligent attempt there at some rehabilitation of conditionality, which ought to be addressed as a key point in the response. We have moved away from the idea that conditionality is a disgrace. We say that it is part of the condition for making progress. That is very true in Africa and Latin America. It would be useful if the Minister could comment on that. The EU can set conditions in its negotiations with Africa and Latin America simply because it cannot easily be accused of, or represented as being, imperialist in the way that an individual country like Britain, France, Spain or Portugal—the whole lot of us—can be separately.
	My conclusion is that this whole exercise has demonstrated the tremendous innate power for development for the better in the world through the developing role of the European Union.

Lord Watson of Richmond: My Lords, I add my congratulations to the noble Lord, Lord Bowness, and his committee for a report which is timely, lucid and highly relevant. The report is precisely titled but, as the debate has already demonstrated, it raises wider questions than the European Union's role at the millennium review summit. Indeed, as the introduction states, it:
	"looks at the EU's role in the UN".
	It does that, to an extent, in the round.
	One key question with wide implications arises within the first section of Chapter 3 of the report, "The EU's importance to the UN". Several references have been made to quite startling data, but if I may mention them again; member states of the EU contribute 38 per cent of the United Nations' regular budget, which compares with 22 per cent contributed by the United States. More than 40 per cent of the UN's peace-keeping role costs are met by EU member states. This question, then, seems to arise logically in my mind: is the EU's role in the United Nations, and through it, commensurate with its budgetary contribution?
	Judging by the way the media see this issue, the answer is, "Certainly not".
	When the UN's future is discussed in terms of crisis, it is often because of US scepticism about the UN and, indeed, the desultory nature of the financial contributions of the United States. By contrast, the European Union's contribution, if it is discussed at all, is taken for granted. I suspect that its extent and dimension is little known, and the committee has made an important contribution to the debate by drawing attention to these figures.
	It is unsurprising, in a way, that the European Union's contribution to the UN is somewhat taken for granted because the European Union is based on multilateralism, as indeed is the UN. To an extent, they are birds of a feather. There are, of course, signs now—and many in the House will be pleased about these signs—that the United States Administration is taking the United Nations more seriously than it did at its outset. It nevertheless remains true that, both in its rhetoric and, indeed, in quite large slices of its thinking, the United States Administration is, by instinct and emotion, seriously unilateralist.
	In giving evidence to the committee, Sir Jeremy Greenstock expressed this most tactfully. He said that United States governments have failed to resolve the dichotomy of wanting, on the one hand,
	"the United Nations to do things to make the world better which the United States does not want to do",
	but opposing the evolution of a global body in the UN,
	"that can take decisions properly the business of the United States".
	That is a very diplomatic expression of the dichotomy, which is clear. It goes to the heart of the difference between the EU and the United Nations, and, indeed, between the EU and the United States, in their approach to these issues. The European Union is not only committed to multilateralism but also, historically and in its whole dynamic, to pooling sovereignty where this enables us to do together what we cannot do separately. In theory, this is what the Security Council is meant to be able to achieve, and historically it occasionally has.
	But it is famously what it was not able to do over Iraq. Again, Sir Jeremy Greenstock explained why. The European Union, like the United Nations,
	"very considerably is governed in its business by decisions of political leaders in their national context".
	States have to agree, on each issue,
	"whether they will be collective rather than national".
	The report concludes that,
	"This was demonstrated by the divisions over the war in Iraq".
	The question for the European Union, however, given the scale of its contribution, is whether it will be more effective—and more true to itself—if agreements to act collectively at the UN are more frequent and, indeed, the norm.
	Does the Minister believe that there is a case for the European Union to be itself represented on a permanent basis in the Security Council? She shakes her head. In that case, because it is not a surprising response—it is a response shared by France for much the same reason—is it not an almost automatic consequence that Her Majesty's Government should consider supporting German membership of the Security Council on a permanent basis?
	Turning to the Doha round, the WTO trade negotiations, the role of the CAP in all this and prospects for the Hong Kong summit, the Government's response to the report's conclusions are admirable as far as they go, which I suggest is not quite far enough. Thus, in responding to the report's challenge in its summary at chapter 8, they state:
	"As EU Presidency, we will work closely with the Commission, our EU partners and other WTO members to build on the progress made so far to ensure a successful and pro-development outcome at the WTO Ministerial Conference in Hong Kong in December. This will allow us to achieve our aim of completing the WTO Round by the end of 2006. A successful trade round has the potential to lift 140 million people off subsidence of less than $2 a day . . . We will continue to press for reform of the CAP and other developed countries' trade-distorting agricultural policies".
	I imagine that that is to a considerable extent a reference to the policies of the United States. They go on to say:
	"Within the WTO Round, we will push for improved market access for developing countries, reductions in trade-distorting domestic support and agreement on an end date for agricultural export subsidies at Hong Kong".
	The trouble with those statements of good intent is, to go back to Sir Jeremy Greenstock's neat phrase, the decisions of political leaders in their national context: specifically, President Chirac being difficult and seeking to prevent Mr Mandelson from being good. There was President Chirac at Hampton Court declaring France's right not to approve any Doha outcome that undermines the 2003 CAP agreement: not 40 per cent cuts; no more than 25 per cent. The noble Lord, Lord Hannay, in this House on Monday, advised President Chirac—I certainly enjoyed this word of advice—to read the Nice treaty, because if he did so he would discover that he had no veto. However, we have a record of signing European treaties allegedly without having read them either.
	Before we all succumb to the pleasures of seeing Mr Mandelson as a righteous crusader—a slightly alarming prospect—let us try to remember that the countries of the developing world do not see even a 40 per cent cut as enabling them to surmount the hurdles facing their agricultural exports. The reason is simple: the Uruguay round set such high ceilings for United States and EU subsidies that insurmountable hurdles will remain even with a 40 per cent CAP cut. Will Her Majesty's Government recognise that and seek despite the difficulties with France and others to go beyond the rhetoric to the realities of what would actually make a difference to agricultural exports from the developing world?
	The Doha round started back in 2001, a journey that I hope will be completed in Hong Kong. But if it is really to alleviate the appalling disadvantages and problems faced by the developing world, a huge amount of work remains to be done. I would like to conclude with a brief example that is very topical. In 2001, the developing countries were promised special and differential treatment in the areas of public health and relevant intellectual property rights. The lack of clarification since 2001 in this area and in particular the failure to meet the deadlines that were accepted at that point of six months or slightly more means that we have reached a situation where, for example, if there was a flu pandemic in the developing world, countries in the developing world could, in theory, like ourselves or other countries in the developed world, overrule patent rights to manufacture the necessary drugs under compulsory licence, but only if they had the manufacturing capacity to do so.
	For example, a country such as Mozambique does not have such manufacturing capacity, so for it to issue a compulsory licence would be futile. It would need in some way to licence another country to act on its behalf as the manufacturer and at present it cannot do so. Will the Minister look at that issue urgently? The report asks the Government to use the remaining weeks of their presidency to make a difference at the United Nations and to advance the development agenda. I am sure that we all hope that that is indeed what will happen.

Lord Dykes: My Lords, I repeat and echo the thanks that have been paid to the chairman and members of the committee—on which I served as well, although I arrived on the scene later than some others—about the excellence of the report, its construction and the help given by our officials.
	This has been an excellent debate. I was particularly grateful for the very interesting organisational requirements for the UN enunciated by my noble friend Lady Falkner. That is a huge subject, which needs more discussion by experts in the future.
	I believe that the EU's role is improving in the UN. It is a considerable role already and needs to be much more cohesive and co-ordinated in the future. It is respected more in the UN because, unlike other leading members of the Security Council, it does not grind those more narrowly based axes. That is a genuine position, which can easily continue. I hope so. And there is no reason why the recent arrival of the 10 new members will change that position.
	The millennium summit was too ambitious in its coverage and suffered from the usual effect of looking much more interesting and compelling before it actually took place. I suppose that was inevitable. It was a long litany of desirable objectives and aspirations for a world where many countries are grappling with sincere and noble goals, including under-developed countries, where the danger is, as the Government have acknowledged, that implementation of reform measures is much harder than talking about them in such a large forum. The idea that all the millennium development goals will be reached in due time is a matter of doubt. On climate change, the crucial post-2012 obligations will, I hope, be dealt with decisively at the UN climate change conference in December, but there is an awful lot of work to be done, and talking, as we know, is easier than doing.
	Will the peacebuilding commission get off the ground eventually? There is room for serious doubt on that as well.
	I am glad that HMG have developed more arguments on conditionality which I believe have been put in the Library, or are about to be. We shall study those carefully.
	The DTI Minister, the noble Lord, Lord Sainsbury of Turville, spoke positively in answer to my Starred Question, on the urgency of the targets referred to by my noble friend Lord Watson for the Hong Kong conference at the end of the year.
	The EU response has already been much more helpful and rapid than that of the United States to many of these things. If the Prime Minister continues to claim a special relationship with an increasingly ailing President Bush, he should, in the time available in the second term, at least make sure that the Americans respond much more energetically than so far demonstrated.
	The Government have also recognised the need to analyse the conditions conducive to the spread of terrorism as well as the normal parts of the counter-terror strategy. That must include a coherent picture, description and recommendations about terrorism in uniform as well, whoever the perpetrators in different countries may be, in the future as in the past.
	Will we also be able to see progress in reform of the UN Security Council, so long overdue but still as elusive as ever, due the entrenched positions of the privileged élite of a small number of leading member states? It was rather depressing to read the press in the UK and elsewhere after the millennium summit, which was described as talking rather than achieving much. According to the Economist in mid-September:
	"Most countries put the blame on the United States, in the form of its abrasive new ambassador, John Bolton, for insisting at the end of August on hundreds of last-minute amendments and a line-by-line renegotiation of a text most others had thought was almost settled".
	According to the international section of the Guardian on 17 September, the only conclusion was "low marks on the final scoreboard". On the same date, the Guardian leader said:
	"Not much can be said in praise of the UN world summit, which has ended with little more than a heavily spun restatement of its loftiest ambitions".
	These are the realities we all face, which is why the Minister has to convince the House that action will be taken. The Independent said in its leading article on the same date:
	"Mr Blair has spent much of this past week attempting to chivvy the UN summit in New York into accepting a universal definition of terrorism. In this he has failed. The motion was rejected by the UN General Assembly".
	One can understand the reasons why.

Lord Hannay of Chiswick: My Lords, I do not believe that that last statement is accurate. The outcome document states that a comprehensive convention on terrorism, which would include a definition, should be agreed during the 60th General Assembly, which runs until next September. Therefore, it is not right to say that it has failed. It is conceivable that it will fail, but it has not done so yet. That throws light on some of the other press cuttings that the noble Lord mentioned. One cannot treat press cuttings as facts.

Lord Dykes: My Lords, the noble Lord, Lord Hannay, is entitled to his opinion and I am certainly entitled to mine. A lot of people regarded the whole exercise of the terrorism examination as extremely disappointing and it is sad that he views it as an official function rather than from a more practical standpoint about the action that is going to be taken. It is perfectly valid to quote from the press, because it is interesting to see how the press considered the summit.
	On 17 September, the Times referred to the Prime Minister's love-in with General Musharraf of Pakistan:
	"But General Musharraf is also a military ruler who has broken his own promises about stepping down as head of the army, and choked off the mainstream political parties".
	The noble Lord, Lord Hannay, and others will perhaps note that I am referring to the reality that many members of the General Assembly feel dismayed about the future of the UN unless more of a balance is injected into its bodies and procedures and the United Nations Security Council is reformed. In that sense, the millennium review has let people down. Perhaps one was unwisely expecting too much. Many things were started in an incipient way, which is a good thing. However, it is much more difficult to reach conclusions than to start things off.
	Iran was mentioned in the context of the UN. The UN Security Council will have a testing time deciding what to do with reference to the EU-3 and so forth at further stages. I must refer to the outburst about Israel from the Iranian President Ahmadinejad, which was mentioned in Questions yesterday. This will be a continuing matter for the UN. It was such a ghastly and violent piece of nonsense and has been happily buried in a veritable avalanche of worldwide condemnation, including from the UN Secretary-General, the Palestinian Authority and others. I was glad to see a strong rebuke from Muhammad Khatami, the former president of Iran, of what the new Iranian president said.
	I speak as a long-standing friend of Israel. I have been heavily involved with Israel for many years. It is a remarkable country. It is a country that is brave and courageous enough to overcome such spurious and rather foolish sounding threats. Of course, there have been attempts by moderate Iranians to go back on what the president said in foolish outbursts on two occasions.
	Israel is a remarkable and courageous country, but it remains the unbeatable military power in the whole zone. That is a solid fact that no amount of hysterical and blustering rhetoric from Iranian racialists such as this new president can gainsay. The reality is that none of this imposes other than a strong obligation on the Sharon-led coalition at long last to commence negotiations with the administration of President Abu Mazen. I am entitled to mention this because the subject came up at the summit in General Assembly speeches and in the corridors and Derrière les coulisses. It is time for the stalling to stop.
	The leading members of the advanced world in the Security Council have long let down the rest of the UN with their disregard for the needs of the third world in basic political terms and their predilection for regarding the UN Security Council at a sort of private estate for their own pattern of dominance. That happened in the beginning of the UN and has continued for many years since. It must change in the future for the General Assembly members, or those rising larger countries—Brazil was mentioned and there are others, such as India and Pakistan—will lose heart about the validity of a modern version of the UN for the future.
	The 34 vetoes that have been exercised by the Americans to stop various Israeli governments behaving more fairly towards Palestine according to international law after nearly 40 years of occupation, is the case in point but there are many others. This pattern of misuse of the UN by the United States and other powers has not stopped since the end of the Cold War. Many active members of the General Assembly feel angry and frustrated, and the West must recognise the need to build a modern 21st century UN that acts for all the members, not just the rich club.
	Because of the positive influence of the European Union, attitudes are at last changing, and the growth of the Asian nations, such as India, China, Indonesia and Japan as world and involved powers at long last—it has taken a long time indeed—will help to right that overdue unfairness and imbalance. The EU has pledged to double aid to the third world, and various other things will happen from now on to give us more cause for hope.
	While I am sceptical about the summit and its detail—I hope that the Minister will reassure us and make us feel more cheerful about what will be done— huge questions remain. There is the peacebuilding commission, the construction of the definition of terrorism in the modern context on a balanced basis, and other matters. Non-proliferation has been referred to, as has the complicated reform of the Security Council, conditionality and the G8 initiatives. They need further monitoring and elucidation by the House.
	World agricultural reforms have been referred to in the debate, and we can take some pleasure from the reality that the common agricultural policy, despite being expensive and old-fashioned, and needing further reform beyond the insipid reforms that have been launched in recent years, is far from being the most expensive of the main farm support systems in the world. The US is much more expensive for a much smaller number of farmers. Japan is similar in its effect. The EU has a better record in taking in ACP food product and staple imports than do some other advanced countries.
	There is a balance in the arguments, but more needs to be done. I hope that the House, the Government and, indeed, the UN will not be complacent.

Lord Astor of Hever: My Lords, this has been a most interesting debate with detailed contributions from all sides. I, too, extend my congratulations to my noble friend Lord Bowness for securing it, and thank him, his committee and its staff for all their hard work in the timely production of the report ahead of the summit.
	As your Lordships have recognised the 2000 UN millennium summit produced a landmark agreement,
	"a blueprint agreed to by all the world's countries and all the world's leading development institutions",
	and the birth of the millennium development goals.
	The eight goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education—all by the target date of 2015. The UN MDG website states:
	"They have galvanized unprecedented efforts to meet the needs of the world's poorest".
	In contrast the millennium review summit 2005 has been described as a "summit of hypocrites"—just another talking shop with little progress on the MDGs. They are goals that, as the report highlighted, Kofi Annan said would not be achieved in the time-scale without significant corrections to many of the developmental policies.
	Does the noble Baroness believe that the millennium development goals can be met by 2015? The UN report, Investing in Development, points out that sub-Saharan Africa, for example, is not on track to meet all millennium development goals. It has the highest rate of under-nourishment with one-third of the population below the minimum level of dietary energy consumption. Sub-Saharan Africa has the lowest primary enrolment rates of all regions. Despite recent progress, gender disparity at the primary level is the lowest of all regions.
	Meanwhile, west Asia, a region that includes many countries typically classified as part of the Middle East, is reportedly not on track for the majority of the goals. Both income poverty and hunger are increasing, and progress toward gender equality has been slow. Primary enrolments increased by only 2 per cent between 1990 and 2001, and mortality rates in under-fives per 1,000 live births in the same period. Maternal mortality remains high and infectious diseases such as TB are still a threat.
	Three years ago, to meet the millennium development goals on water and sanitation, we should have been spending $180 billion a year on all water projects, but we were spending only $80 billion. What reforms have been made to meet the goals? How will Her Majesty's Government ensure their effectiveness? Does the Minister agree with the committee's view that the EU,
	"needs to deploy its diplomatic outreach to countries in Asia, Africa and Latin America"?
	If so, how does that square with the FCO's commitment, of which we heard at Question Time today, to close various embassies around the world by the end of next year?
	We welcome the EU's commitment to increase aid, and we are glad that the Government agree that the commitment must be monitored in light of doubts expressed on whether all member states will be able to deliver the sums pledged. Could the Minister explain in a little more detail whether further action will be taken or penalties imposed, beyond monitoring, if a member state is found to be failing consistently to increase its aid package?
	Despite the increase in aid, I feel that we should question whether more aid is always the answer to poverty reduction and economic development. Nigeria is an example of a country in which, despite swallowing up billions of pounds in aid and oil revenues, living standards have actually fallen over the past two decades. There are significant examples of countries in which aid does not necessarily equal development. It may actually prevent it by providing "easy money" aid flows, which then remove the incentives to reform and grass roots enterprise. What steps are Her Majesty's Government taking to investigate the waste element of UK and European aid? Will the Government ensure that more is filtered through NGOs to target projects rather than to governments who fail to be transparent and accountable? It is vital that we have joined-up governance and government on issues such as trade, aid and security to help to break the cycle of poverty rather than unwittingly add to it.
	The noble Lord, Lord Hannay, in his evidence to the committee, and as a member of the High-Level Panel on Threats, Challenges and Change, suggested that the EU's position at the UN has changed. That is partly due to significant financial contribution to the institution. Secondly, the common foreign and security policy has meant that the EU has become more cohesive and able to deliver according to the UN's needs. Does the Minister agree that the EU will have a real influence on whether the UN will succeed or fail in the current era?
	We shall return to some issues again, particularly in the run-up to the WTO meeting in Hong Kong next month. It is vital that we should heed the UN 2005 report that argues that the,
	"currency of pledges for the international community is by now so severely debased by non-delivery that it is widely perceived as useless. Instead of more grandstanding, world leaders need to knock a few heads together".
	We believe that the UN does have a role to play in today's world, the fight against poverty and security, and within that the EU has an important role. Poverty and security are interlinked but we must be careful not to lose sight of one by concentrating too much on the other. Words are not enough; we need action, efficiency rather than bureaucracy, and transparent, accountable governance at all national and international levels.

Baroness Royall of Blaisdon: My Lords, I am grateful to all noble Lords who have contributed to this important debate on the European Union's role at the millennium review summit. I am also extremely grateful for the work of the noble Lords of Sub-Committee C, notably their excellent chair, the noble Lord, Lord Bowness, on their comprehensive report. As usual, it is of the highest standard.
	As this House will be aware, the Government and the European Union are deeply committed to the United Nations. Since the UN Secretary-General announced his intention to take forward his bold and ambitious reform agenda for the UN by setting up the High-Level Panel on Threats, Challenges and Change, of which the noble Lord, Lord Hannay of Chiswick, was a member, we have underlined at every opportunity our strong support for a more effective United Nations, better able to tackle the interrelated challenges of development, security and human rights, underpinned by an efficient UN Secretariat. That remains the case today.
	That is precisely why the Government and the European Union worked tirelessly for a successful outcome at the UN world summit in September. The reforms agreed, enshrined in the summit's so-called "outcome document", will set the agenda of the United Nations for years to come. They are a set of essential reforms and commitments that will enable the UN to be better equipped to tackle the challenges faced by the modern world. As the noble Lord, Lord Watson, suggested, this debate is an excellent opportunity to draw attention to the vital role of the EU within the United Nations.
	Holding the EU presidency, the UK plays an important role in the often difficult negotiations on the summit outcome document. Gaining consensus agreement on such a broad agenda was always going to be a difficult objective, reflecting the diversity of the UN's membership. But it is to the credit of the members of the United Nations, with the European Union at the fore, that they were able to rise to the challenge and agree on such an extensive set of reforms.
	The bar was set very high. The reports of the high-level panel, Jeffrey Sachs' UN Millennium Project, and Kofi Annan's own report In Larger Freedom demonstrated one inescapable truth: until the international community takes decisive action to address with urgency poverty, disease, environmental degradation and social injustice, we will not be able to achieve sustainable conflict resolution and secure global peace and security. Without peace and security, we cannot tackle development—it is as simple as that. All of these are not possible without universal respect for human rights and the rule of law.
	History has shown that too often the international community has responded to these challenges with dissent and lethargy, driven by conflicting priorities. However, the summit has shown that the international community is at its most powerful and effective when it operates with unity and energy, driven by common goals and purpose. The summit secured firm commitments from both donor and developing countries on development, with several important Gleneagles outcomes endorsed and new EU commitments welcomed by the broader UN membership. These included the need to accelerate progress towards the millennium development goals and to address the special needs of Africa. As the noble Lord, Lord Astor, suggested, people say that it will be extremely difficult for us to reach the millennium development goals by 2015. However, that is what we shall strive to do. Those are our goals and we have to meet them, if at all possible. Together, I hope, we can do it.
	We certainly welcome the mandate given to the Secretary-General to address longer-term reform of the UN development architecture and we hope that this will result in more effective uses of the wealth of expertise, experience and resources within the UN system. We also support the clear commitment made to improving the timeliness and predictability of humanitarian funding. Humanitarian funding is one of the key plinths of our development policy, together with trade and the other part of the triangle.
	Sustainable development was recognised as a key element of the overarching framework of the UN's activities and was integrated throughout the development section of the outcome document, while the UN reform section underlined the need for a more coherent institutional framework for environmental activities in the UN system. Countries at the UN summit committed to move forward the global discussion on long-term co-operative action to address climate change and stressed the importance of the UN climate change conference to be held in Montreal later this month. Yesterday, the first meeting of the dialogue on climate change took place in London.
	At the EU Environment Council on 17 October, the EU agreed its negotiating strategy for the conference in Montreal. Its priority is to get the Kyoto Protocol off to a good start and to ensure that it operates efficiently. The EU confirmed its determination to meet its commitments under the UN Framework Convention and Protocol, including in relation to funding to assist developing countries. The EU also set an objective to launch discussions on a process to determine further action after the Kyoto Protocol's first commitment period.
	The summit's endorsement of the responsibility to protect underlined the obligation on states to protect their own populations from genocide, war crimes, ethnic cleansing and crimes against humanity. Importantly, for the first time, UN member states also acknowledged that the international community should act—through the Security Council—if governments fail to protect their populations from these terrible atrocities.
	The summit's agreement to create by the end of this year a new peacebuilding commission will close an institutional gap in the UN's conflict architecture and will assist countries emerging from conflict. As the holder of the EU presidency, we are working hard to achieve the establishment of the new body by 31 December of this year. There has been progress, including on arrangements for involving the affected countries in the work of the commission. Of course, there remains the need to find satisfactory conclusions on other practical issues, including on how the commission will operate. However, I understand that it is hoped that agreement will be reached in New York on countries being able to self-nominate. If that happens, clearly the peacebuilding commission could help countries to avoid slipping into conflict. The Government see an obvious need for a clear and agreed role for the United Nations Security Council in the peacebuilding commission, and this matter is currently under discussion.
	We have strongly welcomed the agreement to establish a new human rights council to replace the much-maligned Commission on Human Rights. Noble Lords are right when they say that the current commission is both inefficient and much discredited. But we are working hard with EU partners and the wider membership to settle the main elements of the council by the end of December so that the council can start its work as soon as possible in 2006. Human rights must have their proper place within the UN system, and that is right at the heart, or centre, of the UN system.
	I agree that preferably the human rights council should be smaller than the current commission. Obviously that is a very difficult matter for negotiation, but negotiations will continue. Consultations on the council have begun in earnest. The President of the General Assembly, Mr Eliasson, is holding four rounds of open consultation with states in October and November. He is aiming to produce a draft text in the second half of November and to begin detailed negotiations on 28 November with a view to reaching agreement on the main points by the end of the year. I consider that to be very good news for the global system of governance and human rights.
	In respect of terrorism, I was rather astounded to hear the quotation cited by the noble Lord, Lord Dykes, and to hear that he believed everything that he had read in the newspapers. I have participated with him in many debates on the European Union in which we have both urged noble Lords not to believe everything they read about the EU in the newspapers. I respectfully suggest to him that perhaps he should not believe everything that he reads about terrorism and the United Nations.
	Gaining an unequivocal condemnation of terrorism in all its forms and manifestations and, separately, unanimous adoption by the Security Council of the UK's Security Council resolution to prohibit by law incitement to terrorism were useful steps forward. Noble Lords will be glad to know that discussions on the comprehensive convention on international terrorism are ongoing, with the UK presidency participating actively. We welcome the commitment of world leaders at the summit to work to conclude this convention during the current session of the General Assembly, as the noble Lord, Lord Hannay, suggested.
	In response to the noble Baroness, Lady Falkner, about the OIC, the UK and other EU members have been lobbying the OIC on its proposed amendment to the comprehensive convention. The OIC proposal concerns foreign occupation and raises concerns with several delegations that an exception for the definition of terrorism is being sought, but the UK and other delegations are working hard to find a solution.
	Although the primary focus from the perspective of disarmament and non-proliferation this year was rightly the NPT review conference, its disappointing outcome gave us added incentive to make strenuous efforts to remedy that at the UN world summit in September. The Foreign Secretary was pleased to take part in the initiative promoted by his then Norwegian colleague designed to generate broad support for a forward-looking non-proliferation agenda. That is why, as presidency of the European Union, we also worked hard to secure European support for strong and meaningful commitments on non-proliferation and disarmament. From discussion with the new Foreign Minister of Norway last week, I understand that the initiative started by his colleague will continue. It is of course disappointing that the summit was unable to agree on commitments to disarmament and non-proliferation. However, we remain completely committed to exploring ways to achieve progress and to strengthen the global disarmament and non-proliferation regime.
	The IAEA general conference last month demonstrated an especially good spirit of co-operation and determination among states to strengthen non-proliferation and address other issues, such as the peaceful use of nuclear technology. Those are important building blocks. The UN First Committee, presently in session, the UNSCR 1540 Committee and the G8 global partnership are all fora in which we are actively participating and we continue to work hard to bring into force the Comprehensive Test Ban Treaty and to begin negotiations on a fissile material cut-off treaty.
	All those reforms were underpinned by proposals for reform of the UN Secretariat. The world summit recognised that the organisation needs reinvigorating to enable the UN to deliver the challenging mandate that it has been set. That will require an efficient and effective secretariat. Failure to reprioritise activity and modernise working methods risks undermining the wider reforms that the summit set in train.
	Some noble Lords have suggested that reform of the secretariat should be a secondary issue, but the Government's view is that reform of the secretariat is crucial to the implementation of the new UN agenda. We strongly endorse the reforms under way and urge the Secretary-General to be bold in the exercise of his existing mandate. Efforts already under way to strengthen accountability through improved oversight and performance management are welcome. Further reports from the Secretary-General are expected to make proposals for overhaul of financial and human resource regulations that will improve flexibility and transparency in decision-making at the UN. The EU will continue to work closely with the Secretary-General to deliver the management reforms that world leaders have endorsed.
	The lack of agreement that has been apparent for reform of the UN structure reflects the diverse and strong opinions within the UN system. The UK Government support reform of the UN Security Council, and its expansion to include Germany. We also support the extension of the Council to Japan, India and Brazil, as well as permanent African representation. My noble friend Lord Lea suggested that there are lessons to be learnt from past failures.

Lord Watson of Richmond: My Lords, I am most grateful to the noble Baroness for giving way. I thank her for that answer, but can she also deal with the related question of Her Majesty's Government's view of the EU at some point being permanently represented on the UN Security Council?

Baroness Royall of Blaisdon: My Lords, the UN Charter, as it stands, would not allow membership of the EU. I believe that we should therefore leave that question for another day.
	My noble friend Lord Lea of Crondall suggested that we should be looking at new ways to deal more effectively with multilateralism and learn from the lessons of the past. He suggested that there should perhaps be a body set up under the UK presidency. It is an interesting idea, which I shall certainly take to my right honourable friend the Foreign Secretary. However, I think that there are other priorities in the six remaining weeks of the UK presidency. Clearly, however, there are lessons to be learnt.
	Members of the committee have received what I believe to be an excellent policy paper on conditionality, an issue which the noble Lord also raised. We believe that donor programmes must support developing countries' own priorities. The UK programmes respect this, so long as recipients are committed to sound financial management, human rights and reducing poverty.
	The noble Lord, Lord Watson of Richmond, raised many important and difficult issues. Many noble Lords have referred to the amount of money paid by the EU to the UN—38 per cent. The noble Lord asked if our role in the EU is proportionate to our budgetary contribution. The Government believe that it is, absolutely. The EU is a key partner with the UN in a number of fora. For example, there is EU financing for peacekeeping missions, and we played a crucial role in the summit negotiations and implementation. So we are a key player, and it is therefore beholden on us to make a key contribution.
	As the noble Lord, Lord Watson of Richmond, will know, the UK has been at the forefront of CAP negotiations in Doha, arguing for the removal of trade-distorting agricultural subsidies, recognising their negative impact on developing countries. It would not be appropriate for me to say at the Dispatch Box how much we think subsidies should or should not be. That could inflame discussions that Peter Mandelson is involved in. However, the UK is certainly pushing for an agreement that will benefit developing countries.
	The noble Lord also referred to pharmaceutical companies in Mozambique. I am afraid that I do not know the answer to the matter that he raised, but I shall certainly pursue it.
	Although the summit endorsed all the G8 achievements of 2005, particularly on making faster progress towards the MDGs and recognition of the special needs of Africa, some have expressed disappointment and frustration at the results of the world summit. I am delighted, however, that so many noble Lords today clearly understand that real progress took place. I endorse the comments made by the noble Lord, Lord Hannay of Chiswick. I agree that we should give two cheers for the results of the summit, if not three.
	Many felt that the commitments made did not go far enough. In some cases, we share their disappointment. Let us be realistic, however. It is unlikely that, in any summit involving 191 nations, there would be unanimity on the range of issues under discussion. Of course, we wanted the summit to go further in some areas, but if the reforms that we agreed are really implemented—as we are working hard to achieve—the Government are confident that the summit will represent a landmark moment for the United Nations.
	The noble Lord, Lord Bowness, asked whether reform would happen. Clearly, the success of the reforms depends on the political will of the member states. That will is certainly here in the Government, and is shared by other governments within the EU. We are committed to playing an active role in ensuring that the reforms agreed are fully and urgently implemented. This represents a vital part of the EU's goal of an international order based on effective multilateralism and the rule of law.
	Only last week, our ambassadors, acting as the EU presidency, lobbied in all African posts to encourage visible and positive African positions in the ongoing implementation discussions in New York. These outreach efforts will continue as negotiations in New York progress. As the Prime Minister said in New York, if we start implementing urgently the reforms agreed on doubling aid, opening up trade, debt relief, HIV/AIDS, malaria, conflict prevention and stopping genocide, we would have a more modern democracy, less oppression, more freedom, less terrorism, more growth and less poverty. We do not live in an ideal world but we are striving to ensure that the UN can make the world a better place, and we will continue to do so. The results of the summit were exceptionally successful for 191 nations working together in partnership.

Lord Bowness: My Lords, I thank the Minister for her response to the debate and for dealing with noble Lords' questions. It is clear from the debate that there are still issues outstanding: the peacekeeping commission, the human rights commission, the definition of terrorism, the problems of non-proliferation and the reform of the administration. In many ways, this is the start of the story rather than the end. The debate has covered a wide range of subjects. Many of the issues raised could themselves have formed the subject of a debate, whether it be the WTO round or the memorandum circulated on conditionality—I agree with the Minister, although I did not refer to it in the introduction to my report—to say nothing of whether the European Union should have membership of the Security Council.
	However, the report was on the EU's role at the millennium review summit. It is clear from this debate and the report that the EU took a co-ordinated approach. Very detailed work was done over a long period so that the June European Council conclusions could be produced in preparation for the summit. The co-ordinated approach continued. It is interesting to note that the Foreign Secretary was able to make a statement to the General Assembly on behalf of the 25 members of the European Union, the acceding countries of Bulgaria and Romania, the then candidate countries of Turkey and Croatia, the countries of the stabilisation association process and potential candidates Bosnia-Herzegovina, the former Yugoslav republic of Macedonia, Serbia and Montenegro, as well as Ukraine and the Republic of Moldova. They all aligned themselves with that statement. That is quite an impressive achievement for the European Union.
	I thank all noble Lords who have spoken in the debate. All are members of the EU sub-committee, except the noble Lord, Lord Watson, who is a former member. It is perhaps indicative of the commitment of members of the sub-committee to the subject that the noble Lord, Lord Lea, has chosen to spend his birthday evening with us debating the report. It would not be in order for me to move a resolution of happy returns, but we wish him that.

On Question, Motion agreed to.
	House adjourned at two minutes before seven o'clock.
	Wednesday, 2 November 2005.